What Lawyers Can Teach Doctors About Ethics

So THAT'S why they wear masks!

So THAT’S why they wear masks!

Sandeep Jauhar is a cardiologist, the author of “Doctored: The Disillusionment of an American Physician” and “Intern: A Doctor’s Initiation.”and a contributing op-ed writer for the New York Times. He recently penned a column for the paper that raised concerns about threats to doctor-patient confidentiality, specifically from the case, in Washington state, of Volk v. DeMeerleer.

Howard Ashby, a psychiatrist, was sued after his patient, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before shooting himself.  The estate of the victims, Rebecca and Phillip Schiering sued Dr. Ashby, alleging that he breached a duty to warn DeMeerleer’s victims even though the killer had made no specific threats toward the Schierings during his treatment.  Last year, however,  that judgment was reversed by an appeals court, which held that doctors could be required to warn “all foreseeable victims” of their potentially dangerous patients in their care.

It’s a terrible decision, and Jauhar does a good job explaining why. Unfortunately, he also writes this..

“I once took care of a business executive in the emergency room who had hired call girls during a weekend drug binge. When he saw a police officer outside his room, he quietly handed me an envelope containing a large amount of white powder. I wasn’t sure what to do with it, so I discarded it. For the next several hours the patient eyed me suspiciously, probably wondering whether I had ratted him out. But it never occurred to me to do so.”

Well, it should have. Confidentiality is one thing, assisting in a crime is another. The Hippocratic Oath says“What I may see or hear in the course of treatment, I will keep to myself.” That only means, however, that doctors who learn about criminal activity a patient may be involved in is bound not to report it (lawyers have the same obligation).  Jauhar did more than not report criminal activity; he participated in it. He crossed the line by disposing of contraband. Continue reading

Disrespect And Assault In The Operating Room: Our Nightmares Are Real

clown-in-the-operating-room

“A few moments later, the anesthesiologist walks in the room and asks, ‘What do you got?’ Dr. Canby says, ‘Vaginal delivery. Uterine atony. External massage failed. Give her some ketamine.’”…I look at Mrs. Lopez—her eyes are half-closed and vacant. Dr. Canby instructs me to hold her knee. A fellow medical student holds her other knee….Canby then performs an internal bimanual uterine massage. He places his left hand inside her vagina, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That’s what I like. A nice, tight uterus.’ And the bleeding stops. The guy saved her life…But then something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.’ It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ And we stop.”

This is an operating room anecdote related in an anonymously authored article published this week in the Annals of Internal Medicine, a respected medical journal. The publication says that the piece is intended to shine light in a dark corner of the medical profession. Oh-oh. The essay is anonymous, I assume, because the author is afraid that there would be professional repercussions from his revealing this—what? Bad habit? Dirty secret? Crime? Reason for us to go stark, raving mad? Continue reading

When Law Co-Opts Ethics: Florida’s Unconstitutional Pro-Gun Doctor Gag Law Upheld

Unbelievable!

“See doc? That’s what you get for shooting your mouth off! Get it?”

A federal appeals court this week upheld an NRA-crafted Florida law making it illegal for doctors to ask questions and record information about a patient’s gun ownership. Medical groups had challenged the law, arguing that it infringed on doctors’ First Amendment rights.

Which it does. The law is an outrageous incursion on free speech in order to protect gun owners from unwelcome anti-gun lobbying by their physicians.

Among other restrictions, the law says doctors must refrain from asking about gun ownership by patients or family members unless the they believe in “good faith” that the information is relevant to medical care or safety. It also prevent doctors from discriminating against patients or “harassing” them because of owning firearms, which presumably means that it is illegal for a doctor to tell a patient, “You’re too clumsy to own a gun, and if you blow your damn face off, don’t come crying to me.”

“The purpose of the act, as we read it, is not to protect patient privacy by shielding patients from any and all discussion about firearms with their physicians; the act merely requires physicians to refrain from broaching a concededly sensitive topic when they lack any good-faith belief that such information is relevant to the medical care or safety of their patients or others,” said the 2-1 majority opinion, written by Judge Gerald Tjoflat and joined by Judge L. Scott Coogler.

Dissenting Judge Charles Wilson argued that the law violates the First Amendment rights of physicians:

“Simply put, the act is a gag order that prevents doctors from even asking the first question in a conversation about firearms. The act prohibits or significantly chills doctors from expressing their views and providing information to patients about one topic and one topic only, firearms.”

I don’t see how anyone can dispute that analysis. I especially don’t see how the other two judges dispute it.

Doctors shouldn’t use their position of influence to try to impose their political, social and life-style views on patients. If the American Medical Association wants to declare that to be an unethical abuse of a doctor’s status and a patient’s trust, I wouldn’t complain. The law, however, has no more business telling doctors that they can’t advise their patients that owning guns may be bad for their health or their neighbor’s health than it has making it illegal for doctors to tell patients that Donald Trump is just what this country needs in the White House. What’s next, telling dentists that they can’t tell you about their brilliant kids while they’re poking around your mouth?

The state doesn’t have to get involved in what patients and doctors talk about, shouldn’t, and mustn’t. This is a job for ethics, not law. If a doctor won’t stop telling you that the Second Amendment should be repealed, the remedy is easy: tell him to shut up, or you’ll find a new doctor.

Or just shoot him.

Kidding.

_____________________
Pointer: Legal Ethics Forum

Comment of the Day: “Ethics Dunces: Ten Prominent Doctors, Surgeons and Med School Professors Who Want Columbia To Kick Dr. Oz Off Its Faculty”

The late Prof. George Wald, the best teacher I ever had. In biology, not political science. George did not acknowledge the distinction.

The late Prof. George Wald, the best teacher I ever had. In biology, not political science. George did not acknowledge the distinction.

Commenter Alexander Cheezem, who has quite a bit of expertise (also passion) on such matters, weighed in on the current controversy over the “quackery” of daytime TV star “Dr. Oz.” This time I’ll hold my comments until the end; here is Alex’s excellent Comment of the Day on the post, Ethics Dunces: Ten Prominent Doctors, Surgeons and Med School Professors Who Want Columbia To Kick “Dr. Oz” Off Its Faculty:

I’m going to have to both agree and disagree with you here. First off, I applaud Columbia University’s response and agree that the principle of academic freedom is applicable here… to a point.

Secondly, however, I’m going to have to disagree with you regarding the parallels. Linus Pauling was an embarrassment to medicine, not chemistry. Wald was overly passionate about politics, not biology. Nagel’s views on biology are an embarrassment, not his views on what he’s supposed to be actually teaching. Chomsky’s forays into political science may be an embarrassment (personally, I regard them as something of a mixed bag), but that’s not what he was the professor of, is it?

Kass, McKinnon, Harper, and Singer are closer parallels, of course, but there’s still one rather huge difference: Dr. Oz is a doctor… and runs his show as one. It is, as the comedian John Oliver put it, the Dr. Oz Show, not “Check This Shit Out With Some Guy Named Mehmet”. This is quite relevant for a number of reasons, not the least of which is that offering medical advice is within the scope of what doctors do. Offering that advice while invoking his medical license as a relevant qualification, simply put, can be considered part of the actual practice of medicine. Continue reading

Ethics Dunces: Ten Prominent Doctors, Surgeons and Med School Professors Who Want Columbia To Kick “Dr. Oz” Off Its Faculty

Dr Oz

Perhaps they tried this because Columbia has been having a bad ethics year so far… that could be it, I guess.

For the record, here are are the ten prominent individuals in the field of medicine who called on Columbia University to kick Dr. Mehmet Oz, better known to Oprah fans and junk TV addicts as “Dr.Oz,” off its medical school’s faculty:

Henry I. Miller, M.D.
Robert Wesson Fellow in Scientific Philosophy
& Public Policy
Hoover Institution
Stanford University
Stanford, CA

Scott W. Atlas, M.D.
David and Joan Traitel Senior Fellow
Hoover Institution
Stanford University
Stanford, CA

Jack Fisher, M.D.
Professor of Surgery (emeritus)
University of California, San Diego
La Jolla, CA

Shelley Fleet, M.D.
Anesthesiologist
Longwood, FL

Gordon N. Gill, M.D.
Dean (emeritus) of Translational Medicine
University of California, San Diego
La Jolla, CA

Michael H. Mellon, M.D.
Pediatric Allergist
San Diego, CA

Gilbert Ross, M.D.
President (Acting) and Executive Director
American Council on Science and Health
New York, NY

Samuel Schneider, M.D.
Psychiatrist
Princeton, NJ

Glenn Swogger Jr. M.D.
Director of the Will Menninger Center for Applied Behavioral Sciences (retired)The Menninger Foundation
Topeka, KS

Joel E. Tepper, M.D.
Hector MacLean Distinguished Professor of Cancer Research
Dept of Radiation Oncology
University of North Carolina School of Medicine
Chapel Hill, NC

And here is their letter. They are troubled because “Dr. Oz” has embraced dubious products and health promotion techniques on his TV show. Indeed he has. On TV, Dr. Oz is a quack. He uses his medical credentials to, as the letter says, show “disdain for science and for evidence-based medicine” and to display  “baseless and relentless opposition to the genetic engineering of food crops.”  And no one can deny that  “he has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”

None of which is justification for taking him off the faculty, where his teaching duties are unrelated to his lucrative TV persona, and are the direct result of his recognized expertise in cardiothoracic surgery.

Could it be that all of these doctors—including Professors Tepper and Fisher, and Dean Gill— have never encountered the sacred educational principle of  academic freedom? Continue reading

Comment of the Day: “Rationalization #30 (“It’s a bad law/stupid rule”) Chronicles: Vijay Chokalingam’s Affirmative Action Fraud”

On the bright side, Dr. Nick improves the diversity of the medical profession...

On the bright side, Dr. Nick improves the diversity of the medical profession…

Joed68 comes through with his second Comment of the Day, this one in reaction to the post here on Mindy Kaling’s brother and his proud confession that he gamed an affirmative action program to gain admission to medical school years ago.

Allowing skin color to enable a less deserving applicant to vault over a more deserving one in college is one thing—still ethically dubious, but defensible in the abstract—and letting low-lights into elite training for professions with life and death responsibilities is another. The only explanations I can mount for those who indignantly defend affirmative action in the latter (such as CNN’s Jeff Young, quoted in the post) is that they are in thrall of the ends justifies the means mentality currently infecting much of Progressive World, or they don’t know how difficult it is to become a doctor. The first malady is beyond remedy; joed68’s submission addresses the second.

Here is his Comment of the Day on the post “Rationalization #30 (“It’s a bad law/stupid rule”) Chronicles: Vijay Chokalingam’s Affirmative Action Fraud”:

Continue reading

Religion + The Right Of A Woman To Control Her Own Body=Murder

[I am tired, having engaged in a knockdown, drag-out session on legal ethics with a lively group of Federal bar practitioners. This was not the issue I wanted to come home to for the last post of the day. In fact, I gave up and am posting it this morning. Funny, the issue isn’t any easier now than it was yesterday.]

Charles Taze Russell, founder of Jehovah's Witnesses, and still getting kids killed since 1879.

Charles Taze Russell, founder of Jehovah’s Witnesses, and still getting kids killed since 1879.

A pregnant woman who was a Jehovah’s Witness checked into a Sydney, Australia hospital suffering from leukemia. She directed the staff that her treatment could not include blood transfusions, as her religious beliefs forbade them. She suffered from acute promyelocytic leukemia (APL), which is treatable, and often successfully. According to The American Cancer Society, “more than 90% of patients with APL go into remission with standard induction treatment.” Pregnant women with the cancer have an 83 percent remission rate, and their babies have a high rate of survival when their mothers are diagnosed in their second or third trimesters.

In the end, the fetus and the mother died for want of proper treatment.  “Staff were distressed, grappling with what was perceived as two ‘avoidable’ deaths,” doctors at the Prince of Wales Hospital in Australia wrote in a letter published this month in the Internal Medicine Journal.

Well, they should be distressed: they aided and abetted negligent homicide.  Continue reading

Note To Dr. Vesna Roi: Homophobes Can’t Be Doctors….Ethical Ones, Anyway

First, do no harm. Second, don't be a gratuitously cruel asshole.

First, do no harm. Second, don’t be a gratuitously cruel asshole.

Jami and Krista Contreras waited in the exam room for their newborn child’s first checkup. Then they were informed that the doctor they had asked to see had decided, after “much prayer,” that she could not treat the baby because its parents are lesbians.

Presumably the doctor,Vesna Roi, does not habitually require her patients’ parents to fill out a questionnaire to prove the are sufficiently morally worthy to have their infant receive medical care. Nonetheless, so vile does she consider this couple that she feels it is the Lord’s will that she withhold her services from the innocent child they have undertaken to love and raise.

I probably do not need to tell you, and I certainly should not have to remind “Dr”–and I use the title advisedly–Roi that this cruel and hateful conduct is a flaming breach of medical ethics, though no rules should be necessary to persuade a medical professional to have a heart and a soul. Continue reading

Well, Let’s Kill All The Lawyers, Then!

One reason why democracy doesn’t seem to be working very well is that the public is becoming increasingly ignorant about what makes it work at all. Evidence of this trend comes by way of a provocative study by the Pew Research Center, which polled the public regarding which professions it believes contribute the most to society.

The results can be found in this press release, this summary, and this article in The Careerist, but here is a snapshot:

Worth study

Continue reading

Read It And Weep: The Reader’s Digest 100 Most Trusted Americans

Here are the results of a Reader’s Digest poll of “over a thousand” citizens to determine who Americans trust, ranked #1 through #100.

A few observations: Continue reading