medical ethics


Ethics: How Could Doctors Help With Harsh CIA Interrogations, ‘Rectal Feeding’?

(Source: NPR)

(Source: NPR)

It was a stomach-turning morning read. The Boston Globe, reporting on the new Senate report on harsh CIA interrogations, writes: “With the approval of the CIA’s medical staff, some CIA prisoners were subjected to medically unnecessary ‘rectal feeding’ or ‘rectal hydration’ — a technique that the CIA’s chief of interrogations described as a way to exert ‘total control over the detainee.'”

The question immediately arises: How could medical professionals be involved in this? Doesn’t it violate the Hippocratic oath and other tenets of medical ethics?

Dr. J. Wesley Boyd, a Cambridge Health Alliance psychiatrist who’s affiliated with Harvard Medical School’s new Center for Bioethics, has published research papers on relevant ethics awareness among medical students and, this summer, among psychology grad students.

“These actions fly in the face of every ethical standard physicians are held to.”

– Dr. J. Wesley Boyd

He discusses the ethical side of doctors’ and psychologists’ involvement in harsh CIA interrogations on Radio Boston today, and points out that while the American Medical Association and American Psychiatric Association have clearly banned participation in harsh interrogations, the American Psychological Association has not been so definitive.

Some excerpts from what he tells co-host Lisa Mullins:

[Referring to the ethics-awareness study on medical students:]”We had, with that study, objective evidence that medical students were not being taught about any of these issues. The problem with that is that if you end up in military service as a physician, in all likelihood you have no prior instruction about how you should comport yourself if what you’re being asked to do butts up against international codes of conduct and morality more generally.”

“In the early days after 9/11, physicians were being asked to, and expected to, participate in torture…In some instances, they would advise interrogators about the psychological weaknesses of a person. They would advise interrogators about whether or not the person could take a little more punishment or maybe they’re up against death and we need to stop right here. Continue reading


Report: N.M. Traffic Stop Turns Into Forced Enemas, Colonoscopy

(Wikimedia Commons)

(Wikimedia Commons)

It’s the stuff of nightmares.

The New Mexico TV station KOB-TV Channel 4 reports that a man who was pulled over for failing to make a full stop at a stop sign was brought to a hospital and forcibly subjected to repeated anal probes, three enemas and ultimately a colonoscopy.

A drug-sniffing dog indicated a possible odor of drugs on the car seat, and a police officer thought the man, David Eckert, was “clenching his buttocks” when he got out of the car, and wanted his anal cavity searched for drugs, KOB-TV reports. At a nearby emergency room, a doctor refused to do the search, calling it unethical; Eckert was brought to another hospital, where doctors apparently raised no such objections.

From the KOB-4 report, which you can read in full here:

1. Eckert’s abdominal area was x-rayed; no narcotics were found.

2. Doctors then performed an exam of Eckert’s anus with their fingers; no narcotics were found.

3. Doctors performed a second exam of Eckert’s anus with their fingers; no narcotics were found.

4. Doctors penetrated Eckert’s anus to insert an enema.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.

5. Doctors penetrated Eckert’s anus to insert an enema a second time. Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool. No narcotics were found.

6. Doctors penetrated Eckert’s anus to insert an enema a third time. Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool. No narcotics were found.

7. Doctors then x-rayed Eckert again; no narcotics were found.

8. Doctors prepared Eckert for surgery, sedated him, and then performed a colonoscopy where a scope with a camera was inserted into Eckert’s anus, rectum, colon, and large intestines.  No narcotics were found. Continue reading

Call To American Doctors: Denounce Force-Feeding Of Guantanamo Strikers

GUANTANAMO BAY, Cuba (Dec. 31, 2009) A Soldier stands guard in a tower at Camp Delta at Joint Task Force Guantanamo Bay. (U.S. Army photo by Spc. Cody Black/Wikimedia Commons)

GUANTANAMO BAY, Cuba (Dec. 31, 2009) A Soldier stands guard in a tower at Camp Delta at Joint Task Force Guantanamo Bay. (U.S. Army photo by Spc. Cody Black/Wikimedia Commons)

President Obama has promised to shut down the base at Guantanamo Bay, but for now, it continues to fester. And here’s yet one more way it’s morally troubling: A commentary just out in the prestigious New England Journal of Medicine argues that it is medically unethical for the doctors there to participate in force-feeding the dozens of hunger-strikers who have been fasting for weeks in protest.

Written by three Boston University professors — George J. Annas, J.D., M.P.H.; Sondra S. Crosby, M.D.; and Leonard H. Glantz, J.D. — it begins:

American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.

The full piece is here, and The Guardian newspaper quotes the lead author, ethicist George Annas, here:

In an interview, Dr Annas said the force-feeding went against international standards of medical ethics. He said that a hunger strike was a legitimate form of protest – not an attempt to commit suicide – and that the portrayal of doctors at Guantánamo as ethically intervening to preserve life was wrong. “That is at the core of this. These people are not trying to commit suicide. They are risking death to make a political point,” he said.

That is backed up by the World Medical Association, which has declared that force-feeding hunger strikers is “never ethically acceptable”.


Survey: American Doctors Splintered Over Many Ethical Issues

(U.S. Air Force via Wikimedia Commons)

Fascinating. Looks like the recent schism on assisted suicide among Massachusetts doctors is not such an anomaly.

WebMD, the online health information giant, has just released its latest Medscape survey of American doctors’ positions on a host of ethical issues, and the physician community looks not just split but splintered. And who can blame them? These are hard questions, from creative billing to candor with patients, from defensive medicine to “futile” care.

The Medscape 2012 Ethics Survey canvassed more than 24,000 American physicians in August and September on a range of dilemmas. Highlights from the press release:

• Defensive Medicine: When asked if it is acceptable to perform “unnecessary” procedures because of malpractice concerns, 23% of physicians responded “yes”, 55% “no” and 22% said “it depends.”

• Cost Containment: When asked if a patient who is “nonadherent” or “overuses” resources should be dismissed, 32% responded “yes”, 33% said “no”, and 36% said “it depends.”

• Insurance: When asked if insurers should be dropped if they do not pay well, even if longtime patients must stop seeing them, 27% of physicians surveyed responded “yes,” 41% said “no”, and 33% said “it depends.”

• Assisted suicide: When asked if physician-assisted suicide should be allowed in some situations, 47% of physicians said “yes,” 40% said “no”, and 13% said “it depends.”

• ‘Futile’ care: When asked if they would give life-sustaining therapy if they believe it to be futile, 35% said “yes”, 24% said “no”, and 41% said “it depends.”

•  Billing:  Continue reading

‘Ethically, Is This Right For Doctors To Do?’ Help A Terminal Patient Die?

(Photo illustration by Alex Kingsbury/WBUR)

Ravi Parikh, a fourth-year student at Harvard Medical School, faced conflicting messages.

The American Medical Association, which he belongs to, and the Massachusetts Medical Society oppose Question 2, the measure on next month’s state ballot that would allow terminally ill patients to ask a doctor to prescribe them life-ending drugs.

Harvard Medical School student Ravi Parikh

In contrast, The American Medical Student Association, which he also belongs to, supports it.

Ravi faced conflict within as well. He’d applied to medical school for the usual reason — to heal patients, as spelled out in the Hippocratic oath — not to help them die.

But his medical education introduced him to the complexities of modern American dying.

It stressed patient autonomy as a “central guidepost.” Yet he saw patients losing control as they neared death. “No patient that I have spoken to wishes to die in pain, alone, or hooked to a ventilator,” Ravi said, “and yet that is the way in which many patients pass away in the ICU.”

Seeing similar confusion about the ballot measure among his peers, Ravi and fellow fourth-year Grant Smith helped organize a panel discussion for all local medical students earlier this month at Harvard.

It let the audience pepper panelists on each side of the issue with questions, and also use the teaching tool of a case study: A hypothetical elderly man with metastatic cancer who comes to his doctor asking for a lethal prescription.

That case discussion, Ravi said, brought out a valuable consensus among the opposing panelists: All agreed on the need for more and better end-of-life discussions with patients.

But on the “toughest question” — “Ethically, is this right for doctors to do?” — there was no clear answer, he said. Rather, each side argued that its position represented the true embodiment of “Do no harm.”

‘This conversation involves an irresolvable dilemma.’

If Ravi and his fellow students remain conflicted, they can at least be comforted that they are in plenty of good company.

By all indications, the ballot measure presents an extraordinarily difficult problem of medical ethics — a problem wrestled with nationally as states consider physician-assisted suicide laws. Thus far, only Oregon and Washington have passed them; polls suggest that Massachusetts may be next.

The ethical issues involved are hard and deep enough to divide not just medical associations but medical staffs — a Massachusetts General Hospital panel presented arguments for and against Question 2 earlier this month — and seasoned ethicists.

Consider the Boston-based Community Ethics Committee, a group of 18 diverse volunteers who gather to craft opinions on some of the thorniest of bio-medical issues. Continue reading

How Conflict Of Interest Corrodes Trust: One Patient’s Story

“Sunshine laws” are casting more light on payments that doctors receive from drug and device companies — including here in Massachusetts.

Media reports — led by ProPublica — have tended to focus on the payments themselves, listing individual doctors in public databases. But what happens when patients use the databases to check on their own doctors?

In the latest Health Affairs, Maran Wolston, a multiple sclerosis patient who has taught medical ethics, describes her own loss of trust in her neurologist. When she looked him up in Minnesota’s “Dollars for docs” database, she found he had received more than $300,000 from drug companies over three years, including the makers of the drugs he had prescribed for her. How could she help but wonder whether that money might affect his recommendations? It’s a sad and instructive story, well told by an exceptionally savvy patient. She writes:

I knew that I had felt pressured to take medications by my neurologist. When I found that he had been paid large sums of money—six times my yearly salary—to work for the manufacturers of those same drugs, my loss of faith was complete. I never returned to his neurology clinic again. Continue reading