Friday, February 01, 2008

Of Medicine and Murder

Should we credit the Times for allowing the other side to air its opinion?

In the New York Times Health section of a few days ago, Dr. Lawrence K. Altman pondered the wisdom of allowing a convicted murder to practice medicine:

A killer turned healer might seem to be a shining example of prison rehabilitation.... Yet it is hard to think of a case in which a murderer should become a medical doctor. Murder and medical practice are simply incompatible.

True: doctors are expected to be agents of life, not death.

Of course this is the same New York Times whose editorial last year faulted Dr. Kevorkian not for acting in accord with his philosophy, but for the damage his recklessness did to the cause of euthanasia: performing assisted suicides so badly, [Kevorkian] besmirched the movement he hoped to energize. If his antics provided anything of value, it was as a reminder of how much terminally ill patients can suffer and of the need for sane and humane laws allowing carefully regulated assisted suicides....

The tradition in Western medicine of barring doctors from taking life goes back to Hippocrates, whose oath was once obligatory to medical school graduates. As Patrick C. Beeman writes in the latest Touchstone, most medical school oaths omit "the two foundational principles" that "form the distinctive character of the oath"—prohibiting abortion and euthanasia:

In 1993, one hundred percent of American medical schools administered some oath to their graduates. However few actually use what could be called a "Hippocratic Oath," one that preserves its original intent while updating the language. Only 14 percent of the new oaths (Hippocratic or otherwise) prohibit euthanasia, only 8 percent proscribe abortion, and only 11 percent invoke God.

Beeman provides an insightful critique of the modern oaths, including the Oath and Prayer of Maimonides (which he notes were not written by Maimonides), and the 1949 Declaration of Geneva.

The prohibitions in the Oath may have disappeared, but our cultural habits don't change as fast as the elite's moral fashions. Everyone, even readers of the Times, have a visceral understanding that medicine and murder don't go together. Dr. Altman feels obliged toward this revulsion, but for the wrong reasons. As might be expected for these dark days, his argument hinges not on right and wrong, but on subjective criteria: patients might feel uncomfortable knowing themselves under the care of a convicted murderer: "Integrity and trust are the core of the patient-doctor relationship. Any erosion of them could harm the healing process."

Of course, even more fatal to patient trust (not to mention patient) than allowing putatively reformed murders to practice medicine would be allowing practicing doctors to kill patients! If the focus were on the patient's health, instead of his feelings, this consequence would be obvious.

Should we credit the Times for allowing another viewpoint? Probably not.


1. How was Kevorkian's reckless?

The fundamental flaw in Dr. Kevorkian’s crusade was his cavalier, indeed reckless, approach. He was happy to hook up patients without long-term knowledge of their cases or any corroborating medical judgment that they were terminally ill or suffering beyond hope of relief with aggressive palliative care.

The editorial then goes on to cite the precautions in Oregon's euthanasia law as models of proper care and good judgment. Of course the experience in that state and in countries that have legalized the practice is that these precautions present little barrier to, say, greedy or wearied children who want a parent knocked off. Once the dam between life and death is breached, there's no holding back the flood waters.

Lawrence K. Altman, M.D., "When a Murderer Wants to Practice Medicine," New York Times (Jan 29, 2008).

Editorial, "Dr. Kevorkian’s Wrong Way," New York Times (Jun 5, 2007).

Patrick C. Beeman, "Hippocrates Seduced," Touchstone 21:1 (Jan-Feb 2008), 17-19.

More Times coverage of Kevorkian

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