Not only Judicial Activism, but also Medical Protagonism

· Comment, Morality
Authors

In this essay, we touch upon the potential threat to our health, and even our lives, by the medical profession – which, even without prescribing so-called big-pharma drugs, or without explicitly operating under the aegis of a government-run medical plan, may be doing other than what we thought of as their mission as defined in the Hippocratic Oath.  For reasons of prudence, we will not be as hard-hitting as the situation may warrant.

In a previous article, “Church – State Dichotomy: Confused Beginnings and Broader Implications”,  we have at least alluded to judicial activism – the practice by courts to arrogate legislative powers unto themselves.  While others have touched upon this subject in more detail, it is worth mentioning that the balance of powers has thus been harmed by both this process, and by the privileges which the Executive Power claims as its own.

No doubt, the accusation of a usurpation of legislative powers by one branch can be defended by one of the remaining two (such as in the U.S.A., the U.K., and Canada), as long as there seems to be at least a tacit consent for such action. When, for example, in the week prior to this writing, the U.S. Senate decided to reject the President’s wishes by a vote of 97 – 1,[1] we see that ire caused by real or imagined abuse of privilege can lead to what at least is perceived as a rectification of bad policy.

When the policy has to do with the use of military or police forces, and when these can, as will certainly be the case at times, result in death; or when medical plans are mandated at the federal level, the quality – if not the very existence – of life is being defined from on high.

The populace however, believing in the benevolence of their leaders, may consider nothing to be amiss, or at best, such as in Voltaire’s Candide, that one is (still) in the best of all possible worlds.

Whether such a perception is true or not, this writer does believe that from a practical point of view, a greater danger exists, of which nobody has advised him.  This is not to say that others have not noticed, after all, originality is a demanding task.

We have read accusations that the pharmaceutical companies look for advantages in the market-place, and such as I have here stated the “accusation”, it is meaningless – as it can be re-stated to say that they do no more than respond to their stakeholders.  Do not these latter consume the products in which they have an interest?

The danger which we perceive is that of the medical profession engaged in its own species of activism.  This fight which they carry on for their own interests – because as we understand, it cannot be for ours – is out of line with the medical doctors’ commitment to comply with the Hippocratic Oath – where it exists.

Perhaps some readers saw the movie with Sylvester Stallone and Arnold Schwarzenegger, Escape Plan.  Here, a doctor Kyrie, who, in a fashion worthy of Mengele, determines what a subject under extremely harsh forms of punishment is able to withstand without death ensuing therefrom (though this may be a re-interpretation, it is the essence of his role).  Such procedures have been practised elsewhere in the world. We will not discriminate by giving any names.[2]  Perhaps it is worth pointing out that such doctors actually play the role of a god, consider, for example, that “kyrie” is Greek for “lord”.

Be that as it were, the doctor of the movie, after reading a bit about the oath he took, starts back on the road to proper medical profession ethics.

The movie is extremely violent, for which reason we would not recommend it, but we do wish to make the point that the idea of the Hippocratic Oath as shown in this film can leave the viewer with a potentially false impression about the honorability expected of members of the most-highly trained health-care professionals.

What is, after all, an oath, for example, to uphold the Constitution, when the Magna Carta of a nation is no more than a “g__-d___ piece of paper”?  The swearer may feign an ignorance of the language, and confuse “uphold” with “hold up”.  The document may be held up for all to see, vilified, and the question arises, “Well, how long am I to hold it up?  I’ve now complied with my vow!”  And no doubt, a good counsellor could see to it that the requisite duty had been fully complied with.

In the same manner, the Hippocratic Oath could be denigrated.  It, after all, much predates any existing constitution, or any predecessor of the same – coming from about 3000 years ago! Who cares now about the opinions of some ancient Greek of limited medical skills in comparison to those now exercised?  Shall we not now say, as Voltaire said of religion, “Écrasez l’infâme!”

We are not going to go into a line-item analysis of how the Oath is violated.  We do not claim that the violations in the reader’s country are as extreme as they may be in another place.  But it is good to be forewarned, especially if one is ever to visit one of those other lands.

The primary objective is to protect human life. This obligation is arguably violated by some practitioners in a majority of countries, as it conflicts with a supposed human right.  We are not naming the procedure, but when one advances in years, it becomes known as mercy killing.  In the last month we have heard of a youth who decided to have the procedure which was originally meant for the terminally ill of advanced age.[3]

Next on the list of violations of the oath is the revelation of data about a patient to other parties.  This seems to be something mandated by government medical care.  [Our “seems” is a word used deliberately, because not all nations have the same systems, and the Internet has no boundaries.]

We may argue about the severity of a doctor taking risky measures in the interests of a patient’s health.  Strictly-speaking, the Oath does not seem to countenance such action.  A desperate patient might see the situation in a different light.   Here, the physician, and in fewer cases, a surgeon, might be able to obtain support for his actions by arguing in a way suggested in our article on Moral and Ethical Systems for the Determination of Correct Behavior.  That is not to say that the right decision would be arrived at.  Law might have something different to say about the matter.

Our final preoccupation is with the definitions which the medical associations come up with for new diseases, which require new remedies, often untested.  In this case, the public serves as a guinea pig to interests beyond even the doctor, who, however, may be an interested party to any financial benefit.  This is especially true in the field of psychiatry, where the profession deletes and adds disorders according to criteria which some find questionable. Tongue-in-cheek, we may ask, if cannabis withdrawal is a disorder, is the addiction healthy?  If hoarding is a disorder, are we tarring all survivalists as needing counselling?  Might that include the members of the government that are destined for a special underground bunker in case of nuclear attack? And what are we to make of the German government’s recent recommendation that citizens stock up for some kind of critical event?[4]

A lesser form of the preceding is the abuse which the medical profession may permit by prescribing drugs in such a way that they end up ineffectual.  Penicillin, hailed as a wonder in my primary school years, seems next to useless, now, and this example is but the tip of the iceberg. The resistance to this drug can be said to be accidental, as diseases evolve, such as the common cold, or influenza.  The same cannot be said of prescribing a more expensive drug, warfarin, for the cheaper acetylsalicylic acid product which serves the same purpose.  While this latter example is not about drug resistance, a parallel may be drawn to the forced prescription of a more expensive antibiotic when a cheaper one would be adequate.

Having given some concerns about the profession (ignoring the mention of  those who are unequivocally doctors of death of whatever species), we will now produce one more shocking item, one which we believe to be little know by the public.

Never mind those who would intentionally ignore their obligation to uphold the Hippocratic Oath. In at least one country, this author has been told, the medical graduate can choose a modified form of the oath to suit his or her purposes.  This is (if true) similar to the situation in the United States, except that it is the institution of learning which makes the choice for its graduates, as is also the case of at least one or two Latin American countries [Link in Spanish] .  Some countries use only a modified form, or substitute obligations to the medical law, such as in France.  Germany has no oath.  Some of the modifications, or substitutions, are based on objections to swearing to a Greek Pantheon of gods, which is clearly objectionable in Israel and to the Moslem religion.  The C.I.A. is also accused of having their “safety officers”, otherwise understood to be doctors, violate the part of the oath which requires the doctor to “do no harm”.[5]

Any sick person who trusts a medical doctor, based on the noble history of the profession, should that person become the patient of one who has taken who-knows-what version of the oath, cannot be sure of what route the supposed cure would take.

Would the reader want to have a loved one under the care of someone who preferred to omit what was deemed as an essential element of the oath?

Conclusion

This, then, is how we hold medical activism, an activism in its own right, to be a threat to potential patients.

Some doctors, through their medical associations, “promulgate” ideas which are inimical to the Hippocratic Oath, and carry the practices of the profession from their traditions.  In their favor, we can say that this does not constitute malpractice, but that can be no relief for those who lose a loved one to such a form of diagnosis and “remedy”.  Sometimes, this is nothing more than the easy way out for a doctor, in that it might make malpractice insurance cheaper.

Specific instances of the above would be “mercy killing”, the prescription of experimental drugs to existing medical problems, and the definition of new illnesses for the purpose of being able to prescribe treatment – with or without new drugs being involved, for the purpose of advancing financial interests.

We might ask ourselves what particular “oaths” are taken by doctors in special institutions, such as the military, the police, and psychiatric hospitals.  Just last week, this writer saw a strange comment, that one should never commit oneself to one of these latter institutions.  Sometimes, of course, they have served as ersatz jails.

In our fifth foot-note, we note that there is some discussion about whether the Hippocratic Oath actually requires the doctor to do no harm.  This makes it possible for a pressure group, such as those interested in extracting information, to sway a weak-willed, or otherwise comprised professional to do the bidding of more powerful interests.  The Dr. Frankenstein types, of course, need convincing by no one.

In the same vein, we might consider those doctors in the employ of pharmaceutical companies.  The John Le Carré book, The Constant Gardener, and the movie based upon the same, is somewhat based on real events which took place in Africa by such an enterprise.

We have personally met a medical student who wondered what the purpose there was of prolonging life when all it did was to increase world population.  A check on the Internet will show that the idea of depopulation is countenanced in some intellectual circles.  We only question how popular such an idea could really be, because when this question is posed by conspiracy theorists, they ignore the simultaneous discussion about companies maximizing profit, and this does not seem to square with any economic theory that a heavy fall in population would entail healthy profits for companies in such sectors such as food, pharmaceuticals, energy, and transport.

Should that latter scenario actual befall the world, this writer believes we would have gone full circle, back to a state of affairs where the drug companies would not have clients for sophisticated medicines.  Survivors, were the prices to be exorbitant, might well strip willow bark for its analgesic properties, rather than consume a pain-killer containing warfarin.  The distance between medical practitioners would increase, and this would lead to individuals trying to heal themselves, when necessary and possible.

On the other hand, manipulation of DNA through gene-splicing may offer alternatives which we cannot envisage.  But this very manipulation of a building block of life is questioned by some as unethical.  Who pushes for this?

The best doctor, we believe, has taken, and does not violate the Hippocratic Oath, charges no larcenous fees, reveals no secrets, and is not interested in causing death.  We believe that the greatest peccadillo of this practitioner would be to offer a placebo at extremely modest price to the neurasthenic for whom other procedures are counterindicated.

After all, what is the difference between taking bitter medicine with sugar, so as to mask the former’s taste, or taking the latter, perhaps with sweetener, because the patient was unaware of the lack of disagreeable flavor?

At any rate and of this the reader should be aware, there are countries where medical services can be extremely expensive, and it may be advisable to obtain some form of insurance before travelling to them.  It may also be good to know how modern the practices in that country are, and if the doctors would actually sustain life, or drain the pocket-book.

In conclusion, we have given some brief examples of medical activism, whether generated sui generis, or from outside forces.  These have been: the modification, violation, or complete elimination of the Hippocratic Oath, the modification, questionable addition and removal of (usually) psychiatric disorders, and the practice of the profession for lucre over the interests of the patient (here, either surgery or drug prescriptions may apply).  An interesting case of possible misuse of the medical profession to sideline a political opponent exists in the story of one-time governor of Louisiana, Earl Long, who was committed.  If doctors were to be found for every politicial suspected of being mentally unsound, neither totalitarianism nor democracy could exist – it would be the end of government!

October 3, 2016 © Paul Karl Moeller

Notes

[1] S. 2040: Justice Against Sponsors of Terrorism Act, Senate Vote #148 in 2016, https://www.govtrack.us/congress/votes/114-2016/s148, accessed 20161003.

[2] Steven H. Miles, MD, Torture: The Bioethics Perspective, in The Hastings Center, http://www.thehastingscenter.org/briefingbook/torture-the-bioethics-perspective/, accessed 20161003.

[3] In Belgium, a 17-year old has taken the decision, which had to be seconded by his parents.  In the Netherlands, the decision can be taken from age 12.  See: Samantha Olson, “Terminally Ill Child Euthanized In Belgium Becomes First Minor To Die By Physician-Assisted Suicide”, Medical Daily, Sept 18, 2016, http://www.medicaldaily.com/terminally-ill-child-euthanized-belgium-becomes-first-minor-die-physician-398195, accessed 20161003.

[4] Jen Wieczner, “15 new mental illnesses in the DSM-5”, MarketWatch, May 25, 2013, http://www.marketwatch.com/story/15-new-mental-illnesses-in-the-dsm-5-2013-05-22.  DSM-5 refers to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. For the situation in Germany, see David Charter, “Hoard food and water, advises German defence plan”, The Times, August 22 2016, http://www.thetimes.co.uk/article/hoard-food-and-water-advises-german-defence-plan-9qq5j5879, or “Germans told to stockpile food and water for civil defence”, BBC, August 22, 2016, http://www.bbc.com/news/world-europe-37155060. All items in this note accessed 20161004.

[5] Sarah Boseley, “CIA made doctors torture suspected terrorists after 9/11, taskforce finds”, The Guardian, November 4, 2013, https://www.theguardian.com/world/2013/nov/04/cia-doctors-torture-suspected-terrorists-9-11, accessed 20161003.  A certain amount of quibbling suggests that the expression “do no harm” is not literally found in the Oath.

 

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: