Hippocratic Oath

Comment Of The Day: “Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need”

/ Jack Marshall / 20 Comments

I am backed up on Comments of the Day again, especially embarrassing after I announced that I would be posting one a day if possible. Getting one of the comments in the queue last night required trying to use my netbook while watching the Westminster Dog Show with my old Jack Russell feeling insecure and cuddling in my lap. The Update will be late today.

The post about the Oregon hospital being bullied by the local ACLU into placing an illegal immigrant on its transplant list simultaneously raised medical ethics issues and illegal immigration ethics issues, so I am grateful that Zoltar Speaks! resuscitates the topic with his comment. I am particularly greateful for his raising the question, “Is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both?”

My answer, which I think I have made clear over 80,000 posts, is that it is what an action does or can reasonably be expected to do, within the intention and goal of the actor, that makes conduct ethical or not. Unanticipated and unanticipatable results don’t count, and neither does pollution by non-ethical and unethical motives mixed in with the ethical motives, unless they warp the conduct and the decision to engage in it.

There are exceptions, of course.

Here is Zoltar Speaks’ Comment of the Day on the post, Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need:

On one hand there is the Hippocratic Oath that directly implies that medical need trumps things like legal status, so in that regard the policy change is a direct reflection of the core of the Hippocratic Oath and it can be said that they changed their policy to reflect the ethical core of the Hippocratic Oath and present that argument to the public and their actions on the surface can be regarded as ethical. (Yes it’s a run-on sentence)

On the other hand there is the fact that illegal immigrants are literally taking advantage of a near “border-less” country and existing systems in place across the United States that ignore their legal status will allow them to do whatever they want regardless of the fact that they are in the United States illegally and some existing systems in place that actually help them do anything they want because they’re illegal immigrants. The United States has been, and still is, enabling illegal immigrants and this policy change is another system changed that enables illegal immigration.

This leads me directly to a topic that we’ve talked about on Ethics Alarms in the past: is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both? If I remember correctly, I think the general consensus was that it’s the perception of the action that makes it ethical.

The perception of this action is two fold; first ethically complying with the intent of the Hippocratic Oath and second it’s another policy change enabling illegal immigration. Continue reading →

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

/ Jack Marshall / 30 Comments

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 →

Comment of the Day: “‘The Ethicist’ and the Doctor”

/ Jack Marshall / 9 Comments
"Your secret is safe with me, but I have to ask...what that stolen Renoir doing up there?"

“Your secret is safe with me, but I have to ask…what that stolen Renoir doing up there?”

Jeff Long scores his first Comment of the Day with a welcome excursion into the thickets of medical confidentiality. As I expected, many readers were troubled by my support of strict patient-doctor confidentiality as dictates by AMA medical standards. Jeff does an excellent job elaborating on why I (and the professions like law, medicine and the clergy) take the position they do. In professional relationships, trust is essential, and you can trust professions that approve of breaching confidentiality when a damaging secret is involved.

Here is Jeff’s comment, on the post “The Ethicist and the Doctor.”

“First, with regard to Matthew’s example of the cheating spouse who contracts an STD, I think it would probably be difficult to come up with a better example of “the system working as intended.” In the world where doctors respect confidentiality, at least one person gets treated. In the world where the doctor blabs to the world (or at least, to the spouse), there’s a good chance that nobody does. In fact, if the cheater forgoes treatment out of fear of exposure, s/he is putting the spouse at even GREATER risk than in the former scenario, since the STD goes untreated and has a larger window in which to infect the spouse. Certainly, the ideal world is the one where the cheater gets treated AND confesses to the spouse, but the onus for that lies with the cheater. It’s not the doctor’s place. Continue reading →

“The Ethicist” and the Doctor

/ Jack Marshall / 17 Comments
It's all Greek to "The Ethicist"!

It’s all Greek to “The Ethicist”!

The third New York Times writer to take over the mantle of “The Ethicist” column, Chuck Klosterman, may be the most reliable yet, but he ended up wandering into the ethical weeds in his recent advice to an ethically-perplexed doctor, and engaging in advice column malpractice.

A physician asked him what was his ethical course when a patient divulged to him that his persistent headaches may have arisen from the stress of keeping a secret: he was responsible for a crime that had been pinned on an innocent man. Before the consultation, the doctor had promised his patient that “whatever he told me would not leave the room.”  Now the physician was having second doubts, and wondered if he was right to keep the confidence to his patient at the expense of an innocent man’s freedom and reputation.

Klosterman’s answer:

“I would advise the following: Call the patient back into your office. Urge him to confess what happened to the authorities and tell him you will assist him in any way possible (helping him find a lawyer before going to the police, etc.). If he balks, you will have to go a step further; you will have to tell him that you were wrong to promise him confidentiality and that your desire for social justice is greater than your personal integrity as a professional confidant.”

First of all, I don’t understand why a doctor is asking this question to a newspaper ethicist unless he doesn’t like what professional and medical ethicists are telling him. Klosterman, in reaching his reasonable-sounding but flat-out wrong reply, simply discards the concept of professionalism, beginning with the Hippocratic Oath…. Continue reading →

Comment of the Day: “Nomination For Enshrinement in the Hall Of Bad Ethics Ideas: A Hippocratic Oath For Scientists”

/ Jack Marshall / 2 Comments

Zoebrain, the Aussie researcher who has enlightened many Ethics Alarms debates, provides delicious perspective to the post regarding scientific ethics, specifically regarding the question of whether scientists can or should pledge, like doctors, to “do no harm.”

Here is her Comment of the Day to Nomination For Enshrinement in the Hall Of Bad Ethics Ideas: A Hippocratic Oath For Scientists:

“Tell the truth, the whole truth – but possibly not nothing but the truth, as long as any opinion is unmistakably marked as such. Correct your past mistakes as you find them. Also be prepared to accept responsibility for the moral consequences of the power you provide to others being misused. Unless you feel it right to give them the power, you must accept personal responsibility and so withhold it. That’s not a Scientific sin, it’s a personal one.

“Providing the sharpest possible scalpel to a surgeon is one thing. Providing it to a vivisectionist of “untermenschen” another. Providing it as a toy for a 6-month-old baby yet another.

“The only scientific sins are knowing falsification of results, and omitting contradictory evidence. But scientists have responsibilities as humans too.

“Please have a listen to this song [ by musical satirist/scholar Tom Lehrer’s “Werner Von Braun,” about the amoral Nazi-turned-U.S. rocket-scientist.]:

Continue reading →

Nomination For Enshrinement in the Hall Of Bad Ethics Ideas: A Hippocratic Oath For Scientists

/ Jack Marshall / 8 Comments

Nope. No sewing machine. It will cause too much “harm.”

A blogger for the Lindau Nobel community asks, as a follow-up to a discussion raised in one of the august group’s recent meetings, whether scientists should have to take an oath similar to that traditionally (but not universally, by the way) taken by physicians, a pledge to “do no harm.”

No. Next question!

This is not merely a bad idea, but an arrogant and ignorant one. The medical profession is dedicated to healing, without regard to who is being healed. “First, do no harm” is a rational and excellent absolute principle, one that relieves the profession of the burden of many (but not all) complex utilitarian dilemmas that doctors and other health professionals may not be equipped to solve. Medicine is much narrower than science, and its limitations more clear. Most people would agree with doctors on what constitutes “harm” in 99% of the situations where the issue would be raised. Not so science, where one man’s monstrosity is another’s giant step for mankind. Continue reading →