Doctors' Dilemma

Dr. Dietrich Schultze, 57, devoted half a lifetime to building up his professional skill and practice as an ear, nose and throat specialist in the Thuringian kreis (county) of Hildburghausen. but he could no longer stick the place. The Red Party bosses of East Germany had promised Dr. Schultze time and again that his children could go to universities, and time and again reneged. Early this month -- like more than 3,300 other doctors since 1954 -- Dr. Schultze slipped over the nearby border into West Germany with his family. His flight left Hildburghausen (pop. 65,000) with only one private physician, a general practitioner.

At that, the people of Hildburghausen were relatively lucky. They had a county hospital and six rural "ambulatoriums'' (clinics). In the county of Gardelegen, not a single private practitioner was left for 55,000 people, and they had only one county hospital -- understaffed because many hospital doctors have joined the exodus to the West. In Rostock, one remaining eye specialist, a 72-year-old man, keeps a ten-hour-a-day schedule. The flow of fleeing physicians has reached a flood stage of 800 or more a year, and shows no signs of subsiding. Remaining doctors, especially the relatively few in private practice, are grossly overworked, and patients are under-doctored.

A Duty to Stay? As a result, both physicians and laymen in both East and West Germany are hotly debating the question: Has a physician the right to flee for private reasons, or is it his bounden duty to stay for the sake of his patients?

Impressive reasons argue for staying. East German doctors can actually earn more than most of their West German colleagues and can usually command a house and car. And West Germany is officially opposed to the exodus, partly because West Germany has a surplus of doctors, partly because the government believes that if the spark of liberty is to be kept alive in East Germany, some intellectual leaders must remain. Minister for All-German Affairs Ernst Lemmer says carefully: "We wish these represent atives of the German intelligentsia would stick it out and lend their fellow citizens a moral and spiritual helping hand."

A Need to Flee. But even more impressive reasons argue for going. The jack-booted regime has a genius for antagonizing intellectuals -- even those it is most anxious to placate. It denies doctors the right to prescribe any drugs not made in Iron Curtain countries. It puts pressure on them to rush workers back to their jobs, to put productivity above professional judgment. A West German physician sympathizes: "Any reputable doctor recognizes his ethical duty to his patients. But he also has an ethical duty to his children. And suppose the authorities demand that he make confidential reports on the political attitudes of his patients and colleagues?"

The East German bosses do just that. Dr. Hans Klamp was prepared to stay as head of an employee clinic in Gartz--until the Communist Regional Council ordered him to deliver weekly intelligence reports on his patients. In Briissow the security police wanted to "bug'' a private-consultation room so they could tape-record patients' complaints. The doctor decided that ethics and morality left him no choice. He fled.

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