Do Doctors Have a Moral Obligation to Provide Physical Wellness Training?

In a recent article on the website Total Brain Health titled “Do We Have a Moral Obligation to Provide Brain Wellness Training?”, Dr. Cynthia Green argues that medical practitioners have a burden to educate and empower patients to improve their brain health. As evidence, Green cites the magnitude of dementia, the science behind certain brain health interventions and the tools available to physicians to help their patients make these health improvements. In this article, I will break down Green’s argument and show how it applies to physical wellness training. Like brain health, our sedentary society has spawned an uptick in a variety of diseases, and there is research in support of physical health interventions to treat those diseases. Given Green’s reasoning, it seems a similar moral obligation exists in regards to physical wellness training.

Three Arguments for Brain Wellness Training

Green begins by citing the Lancet Commission on Dementia Prevention, Intervention and Care: “… Giving people information about how to prevent or treat dementia is an essential first step, but is not enough. There is a responsibility, not just as professionals but as a society, to implement this evidence into interventions that are widely and effectively used. …Interventions have to be accessible, sustainable, and, if possible, enjoyable or they will be unused.”

She then issues her colleagues a challenge “to move brain health to the forefront of our health promotion initiatives” for three reasons. First, several well-designed studies show that certain factors influence dementia risk. These factors include levels of childhood education, social isolation in older age, physical activity and hearing loss. Moreover, specific lifestyle interventions like physical exercise may slow cognitive decline in patients diagnosed with memory disorders.

Do Doctors Have a Moral Obligation to Provide Physical Wellness Training?
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Second, dementia has grown into a massive worldwide crisis. 45 million people around the globe currently have a dementia diagnosis. According to the 2015 World Alzheimer’s Report, the economic cost of the disease is so great that if dementia were a country, it would be the eighteenth largest economy in the world. And these numbers don’t even consider the devastating emotional costs to the affected individual and her family, friends and community.

Third, brain health practitioners have the tools to provide better care to their patients. Green echoes the Lancet Commission’s reproach that giving patients information about brain wellness training is no longer enough. Practitioners should strive to develop innovative methods to lower dementia risk and improve cognitive function. And they should provide engaging and challenging programs that empower people to take better care of their brains.

Green concludes that, given the evidence for certain brain health interventions and the societal need for better brain health, physicians have a moral burden to act and give patients the tools to protect and promote their cognitive wellness. This move seems like a big step. It’s one thing to encourage physicians to recommend and provide patients specific brain training programs instead of giving them vague instructions or handing them a pamphlet about brain wellness. It’s another thing to claim that physicians who don’t do the former are acting immorally.

Moral Obligations in Medicine

Let’s take a step back and ask what obligations healthcare practitioners have to their patients. According to the American Medical Association Code of Ethics, “While a physician’s role tends to focus on diagnosing and treating illness once it occurs, physicians also have a professional commitment to prevent disease and promote health and well-being for their patients and the community.” This statement provides a better foundation for moral claims about healthcare. It says that physicians have an ethical obligation to prevent disease and promote wellness. So physicians treating dementia patients have a duty to slow the progression of dementia as best they can and to actively promote better brain health. Given the science behind certain dementia interventions and the tools at physicians’ disposal, these ethical guidelines provide the force for the claim that physicians have a moral obligation to provide brain wellness training for their patients.

But once we understand this argument, we must recognize that it applies to more than brain wellness training and dementia. The AMA Code of Ethics applies to all physicians, whether they treat patients with dementia, Alzheimer’s, diabetes, heart disease or any other malady. All doctors have an ethical obligation to prevent disease and promote health and well-being for their patients and the community.

Three Arguments for Physical Wellness Training

Beyond Green’s observations that “Specific lifestyle interventions, such as physical exercise and meditation, may slow decline in those diagnosed with memory disorders” and “Leaders in the field… have in fact recently suggested physical activity be prescribed to those with early memory loss,” the medical field is aware of many other health benefits to physical wellness training. At this point, asking “what doesn’t exercise help?” will generate a far shorter list than asking what ailments it does improve.

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And aside from dementia and its 45 million patients, cardiovascular disease is the most common cause of death around the world, accounting for 17.3 million of 54 million total deaths in 2013. In 2012, 14.1 million new patients were diagnosed with cancer, and the disease caused 8.2 million deaths worldwide. 422 million people around the globe have diabetes, almost four times the total from 1980 and almost ten times the number of dementia patients. And exercise has been shown to help treat or lower the risk for all of these conditions.

Moreover, tools are available to help doctors provide physical wellness training. The U.S.-based initiative Exercise is Medicine offers evidence-based resources to help doctors prescribe exercise, including patient assessments and exercise guidelines. In Canada, programs like the Live Well Exercise Clinics provide supervised physical training for those seeking to treat conditions like diabetes, high blood pressure, cardiovascular disease and complications related to obesity.

A Moral Obligation for Physical Wellness Training

So keeping in mind the AMA Code of Ethics and following Dr. Green’s argument, doctors have an ethical obligation to provide their patients with physical wellness training (or at least refer them to someone who can provide such training). If we accept that doctors have a moral obligation to provide brain wellness training because of the research-based evidence in favor of such training, the worldwide prevalence of dementia and the availability of tools for doctors to help patients improve their brain health, we ought to accept that similar obligation exists for physical wellness training.

This conclusion is not a new one. The existence of Exercise is Medicine, Live Well and similar initiatives is evidence of the belief that the medical field should explore physical training as a complement or alternative to commonly accepted treatments. Doctors like Ranit Mishori have made similar calls for prescribing physical wellness training. But Dr. Green’s brain training argument highlights the moral force behind this movement.