Medical Misconduct, Past and Present. Objective Quantification.
This blog establishes parameters to use to quantify the extent of medical misconduct. This should be used for present day medical miscreants and for revisionist re-evaluation of medical pioneers in the past.
These are the important criteria.
5 general criteria can be employed:
How severe was the pain or injury inflicted upon the individual.
How permanent were the injuries of the interventions upon the individual.
Was there any prospect of benefit to the individual.
Were individuals aware that they were experimented on.
Were treatments/ experiments done against their will.
So, starting with the gold standard of Medical misconduct. Nazi doctors experimenting on Jews in concentration camps. essentially all 5 above mentioned criteria were at the worst rating. Understandably all the types of experiments and their findings have been shunned and suppressed by the non-Nazi medical community at the time, and by the entire medical community up through the present.
The medical pioneer I highlighted in an earlier blog to revise the historical view as a monster and not a pioneer is Dr Sims also checked off most of these boxes, ith especially heinous that this was done against the black womens' will. The one caveat in his account is that it did achieve benefit in understanding for the global community of patients, which is the mediating criteria:
6. Was there benefit to humankind.
It is a debatable point, and one that is important to debate: did that end justify the means?
In all medical ethics classes a US government sanctioned medical experiment is used to illustrate our own Nazi-like experimentation.
The Tuskegee black military airmen syphilis experiment. You should look this up on your own.
Although the common practice in modern medicine is to distinguish clinical care and medical research. I don't really do so.
The principle that is shared by both, and is at the core of medical care is:
Patient information is critical.
Individuals must be made aware of the risks, importantly the likelihood of risks (this is a gray area I will discuss in the future). Essentially everything (by which I mean everything, extending this concept to beyond medical care) has the risk of death, but how likely is it? So saying you can die, generally is understood by medical practitioners as unnecessarily increasing the anxiety of patients (and yes they can die from the anxiety), without serving benefit, and most likely causing harm.. So wisdom-sense must be used, which I will describe in an upcoming blog.
A number of individuals will also allow some things to be done that may not benefit them, but with the knowledge that this may benefit others in the future. But they should know this, and be the ones making that decision, and not have the doctor make that decision for them.
The importance of informing patients is true both at the time of care, and also after the fact. After the fact may be especially important, as it is often overlooked, and both the medical responsibility and ethical obligation of the principle bodies involved in patient care. So whereas it is well understood if you give a person a disease without their knowledge, and do not offer treatment, but instead plan to watch the natural history unfold (what happened to the Tuskegee airmen), after the event, the moral imperative is to inform them and offer them compensation for the damages done. However to the present time, most medical misconducts are still covered up by medical institutions, which is immoral and shameful. This is at the core of many of the recently-in-the-news medical misconducts regarding sexual molestation by male medical practitioners of mainly female patents, but also of male. These primarily violated point 1 above, but were not of the worst kind of injury. More severe injury (severity as well can be stratified), still largely lurk in the shadows, covered up.
The simple concept that involves basically all of this:
treat people as you would want to be treated yourself.
This is the guiding principle that I use. This also includes treating people decently and preserving their dignity.
Life has a strange way of working out, it is not clear to me why the burden of revealing and quantifying medical misconduct and injuries has largely it seems fallen on my shoulders. It is a combination of integrity (which most physicians have to a considerable extent) and courage (which is mostly absent in medical practitioners [and the majority of people in general] as the story-line of the known and concealed medical miscreants are evidence of).
Protector Publicus (latin).
Richard Semelka, MD.