Historical Context and the 1793 Decree
“Who saves a life, saves the whole world,” teaches the Talmud. In 1793, Viceroy Conde de Revillagigedo issued a decree to the Royal Protomedicato Tribunal, mandating that all doctors, apothecaries, surgeons, and midwives respond immediately to calls for medical assistance without frivolous excuses or delays. This directive addressed a recurring issue: some medical professionals refused to attend patients at night or in dangerous situations, jeopardizing both patient lives and the administration of justice.
This decree wasn’t new. In 1777, Viceroy Bucareli had issued a similar order, compelling surgeons to attend any injured person immediately without judicial orders and imposing economic sanctions and exile for noncompliance. The underlying message was clear: public health, safety, and justice depended on the unwavering commitment of healthcare professionals, even when their personal safety was at risk.
The Evolution of the Dilemma
Over two centuries have passed since that decree, yet the core issue remains relevant in Mexico: ensuring medical professionals attend to the population despite personal risks.
During the COVID-19 pandemic, Mexico became one of the countries with the highest numbers of healthcare worker deaths. Doctors, nurses, and ambulance drivers faced the virus with insufficient supplies, grueling hours, and often inadequate protective gear. The toll was tragic: hundreds of healthcare workers lost their lives fulfilling this duty, which has been considered an ethical and social obligation since colonial times.
However, the tragedy didn’t end with the pandemic. Today, Mexican healthcare professionals face another threat: crime-related violence and insecurity in rural areas. Young doctors on community service are sent to isolated communities without minimal security guarantees. Some have been attacked, kidnapped, or killed simply for being in the wrong place at the right time while fulfilling their duty to attend those most in need.
The State’s Responsibility
Unlike the colonial past, today’s Mexican state has a constitutional duty to protect its healthcare workers, provide them with resources, working conditions, and security. Yet, the pattern persists: demanding individual heroism to compensate for structural shortcomings in a system that still fails to meet essential needs.
Imagine two scenarios: In 1793 Mexico City, a surgeon receives a nighttime call to attend a stabbing victim. The neighborhood is dangerous, and he knows his life is at risk upon leaving. Yet, the viceroy’s order is clear: he must attend or face economic sanctions, exile, or imprisonment. He takes his instruments and steps into the dark street, knowing his duty exposes him.
In 2025 Guerrero’s Sierra, a doctor on community service is assigned to a rural clinic with insufficient medications and security. One night, an armed group invades the community; the doctor becomes a victim not due to negligence but merely for fulfilling her duty. Both stories illustrate the same principle: the state demands adherence but doesn’t always ensure protection.
Reevaluating the Social Pact
The debate must now transcend acknowledging doctors’ sacrifices. It’s about reassessing the social pact with those who uphold the right to health in Mexico. It’s unacceptable that they continue being cannon fodder against pandemics without proper equipment or face violence in crime-controlled territories.
The echo of the 1793 decree reminds us that authorities have long appealed to unwavering medical responsibility. Yet, two centuries later, the inconvenient question is whether the state has learned to fulfill its part of the pact? Are we still repeating the same story, demanding unconditional dedication without ensuring safety or dignity?
Dr. Éctor Jaime Ramírez Barba, a general surgery specialist, public health certified, and doctorate holder in health and public administration, is a legislator and advocate for Mexico’s public health. He is a reelected PAN group member in the LXVI Legislature.
Key Questions and Answers
- Q: What was the 1793 decree about? A: The decree mandated medical professionals to attend patients without excuses or delays, addressing the issue of doctors refusing nighttime or dangerous situations.
- Q: How does this historical decree relate to modern-day challenges? A: The core issue of ensuring medical professionals’ safety while fulfilling their duty remains relevant, as seen in the COVID-19 pandemic and threats from crime-related violence.
- Q: What is the state’s responsibility towards healthcare workers? A: The Mexican state has a constitutional duty to protect, provide resources, and ensure security for its healthcare workers.
- Q: Why is reevaluating the social pact important? A: It’s crucial to ensure healthcare workers’ safety and dignity, as they should not be expected to make excessive personal sacrifices due to systemic shortcomings.
