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Monday, January 23, 2012

Does Your Doc Have Ethics?


The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in Ionic Greek (late 5th century BC).
Most people identify it with historic and traditional value. The Hippocratic Oath is considered a rite of passage for practitioners of medicine in many countries, although today the modernized version of the text varies among them.

Would it surprise you to know not all medical schools require their graduating doctors take the Hippocratic Oath? Would it surprise you even more to know the content of the medical pact greatly varies?

Medicine's use of the oath changes over time. Here are some items for your consideration, the results of a study by Robert Orr, M.D. and Norman Pang, M.D., in which 157 deans of allopathic and osteopathic schools of medicine in Canada and the United States were surveyed regarding the use of the Hippocratic Oath:

1. In 1993, 98% of schools administered some form of the Oath.
2. In 1928, only 26% of schools administered some form of the Oath.
3. Only 1 school used the original Hippocratic Oath.
4. 68 schools used versions of the original Hippocratic Oath.
5. 100% of current Oaths pledge a commitment to patients.
6. Only 43% vow to be accountable for their actions.
7. 14% include a prohibition against euthanasia.
8. Only 11% invoke a deity.
9. 8% prohibit abortion.
10. Only 3% prohibit sexual contact with patients.

Though the oath has been rewritten over the centuries, the essence of it has remained the same:

"In each house I go, 
I go only for the good of my patients." 

Yes, I know house calls are largely a thing of the past. But, does the modern oath even require the physician to promise "doing good"? Perhaps most telling about the current intent, while the classical oath calls for "the opposite" of pleasure and fame for those who transgress the oath, fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge. (Peter Tyson, "The Hippocratic Oath Today," NOVA, pbs.org, March 27 2001)

Most modern oaths, in fact, are penalty-free, 
with no threat to potential transgressors 
of loss of practice or even of face.

The American Medical Association once held the oath as a covenant, a solemn and binding treaty, but many modern oaths have a bland, generalized air of "best wishes" about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced.

Some physicians claim that the principles enshrined in the oath never constituted a shared core of moral values, that the oath's pagan origins and moral cast make it antithetical to beliefs held by Christians, Jews, and Muslims. Others note that the classical Oath makes no mention of such contemporary issues as the ethics of experimentation, team care, or a doctor's societal or legal responsibilities.

Today the traditional administration of an ethical oath for physicians is beginning to lose moral force. "The original oath is redolent of a covenant, a solemn and binding treaty," writes Dr. David Graham in JAMA, the Journal of the American Medical Association (December 13, 2000). "By contrast, many modern oaths have a bland, generalized air of 'best wishes' about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced." (The Hippocratic Oath Today: Meaningless Relic or Invaluable Moral Guide? http://www.pbs.org/wgbh/nova/doctors/oath_today.html)

Many believe the Hippocratic Oath has ceased to be a moral force or a guiding ideal for physicians. Do many modern physicians break away from the traditional medical covenant of respect for life? Do maverick physicians no longer believe the purpose of medicine is to heal and save lives?

Undoubtedly, the public must accept the fact that a recognized segment of the science of medicine has become instrumental for ending lives. Consider abortion, euthanasia, and assisted suicide. Aren't the physicians who practice these procedures theoretical "instruments" of death?  Yolly Eileen A. Gamutan, R.N., states:

"As for them (break-away physicians), 
no longer is the ethics of Hippocrates 
relevant since the abiding motto of Hippocrates had been:
'First, do no harm.'
As for these physicians, 
the Hippocratic medical covenant 
is as meaningless as the Mosaic covenant: 
'Thou shalt not kill.'"
 
 (Yolly Eileen A. Gamutan, "The Hippocratic Oath," 
Catholic Association of Doctors and Nurses, http://www.acim-asia.com)

In fact, Dr. Gregg Bloche, says the principles of the oath are under an “unprecedented threat.” In The Hippocratic Myth, Bloche details how doctors are under constant pressure to compromise or ration their care in order to please lawmakers, lawyers and insurance companies. ("Medicine's Rising Costs Put Hippocratic Oath at Risk, National Public Radio, March 16 2011) Dr. Bloche includes these reasons for the threat to the oath:

1. Medically necessary care is a wide open term. 

Dr. Bloche believes doctors are increasingly expected to decide which expensive tests and treatments they can and cannot provide for their patients. Their dual role as examiner and cost-cutter can then potentially compromise patients' care, he says, particularly when insurers and hospital administrators urge physicians to only perform "medically necessary" treatment.

2. Good medical care may be denied in favor of subpar treatment. 

This could happen for a variety of reasons, including whether patients have consented to cheaper treatment options through their health insurance plans. What that means, he says, is that doctors who ration care on behalf of insurance providers may simply be following their patients' wishes — even if patients are not aware that they're receiving the best treatment.

3. The choices of health plans aren't made clear in the employee benefits office.

Dr. Bloche explains, "In the real world, the cheap health plan and the expensive health plan both promise you 'medically necessary' care and you don't really know what that means. So you sign up for this care and you think, 'Aha! This one's cheaper than the other. And it's promising medically necessary care. You don't really know that one car is a Lexus and one car is a Chevy."

Considering all of the changes, controversy and conditions, is the Hippocratic Oath, in actuality, a Hypocritical Oath? In other words, do physicians need to pledge to a common moral code? I certainly believe they do need to be bound to definite moral guidelines. And so does Daniel G. Deschler, M.D., FACS.

Dr. Deschler explains that physicians traditionally take a Hippocratic Oath (of some form) at a critical time in their development, setting the moment separate from the previous process and laying the groundwork for their future careers and their future care of patients. Whether legally binding or not, it is a sign of personal importance, commitment, and solemnity as are births, marriages, and burials. For such times, the wording may not be exact, but the basic human emotions conveyed are universal: celebration, commitment, and mourning.

A Hippocratic Oath intends to convey physicians' inner emotions and thoughts as they pass from one stage of their journey (medical school) to the next stages of training and providing care. According to Dr. Deschler, whether modern or traditional forms are used, these physicians employ the oath to bond with their fellow students in the moment, join their mentors in the present, and recognize their predecessors.

Dr. Deschler says, "Yes, I believe 'a' Hippocratic Oath is relevant—for me in June of 1990 (when I took it), in March of 2001, and every day of my life in this profession in which I am honored to be a member. What is the essence of a Hippocratic Oath? Simple and echoed throughout time, whatever the words: 'May I care for others as I would have them care for me.'" (Peter Tyson, "The Hippocratic Oath Today," NOVA, pbs.org, March 27 2001)


The AMA Code of Ethics

The AMA Code of Ethics, although not an oath but a statement of ethical conduct, is accepted by physicians as a legitimate statement of duties of behavior to which all physicians should subscribe. The AMA statement is not an oath but a model, which those belonging to the AMA (or even those not belonging) accept as a fair statement of behavior and duties of all physicians. It does not differ essentially from what is considered proper behavior in other Western democracies:

The AMA Code of Ethics

Preamble:

 
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

 
I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

 
II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

 
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

 
IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

 
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

 
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

 
VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

 
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

 
IX. A physician shall support access to medical care for all people.

 
Adopted June 1957; revised June 1980; revised June 2001.

Now America Has the Pill Mill and Greedy Physicians

You are probably aware of Dr. Conrad Murray and Michael Jackson. And, I'm sure you know about Dr. "Nick" George Constantine Nichopoulos and Elvis. But, have you ever heard of Dr. Julio Diaz and his work in Santa Barbara, California? ("Calif Doctor Arrested In Rx Abuse Case, Associated Press, January 6, 2012)

Let me tell you a little about the "good" doctor. Entire article here: http://workstations.digitalmedianet.com/article/Calif-doctor-arrested-in-Rx-abuse-case-1825274

Dr. Diaz supplied OxyContin, Vicodin,Norco and other drugs to addicts with no legitimate need for the powerful narcotics. Some patients diverted the pills to the black market or suffered fatal overdoses, authorities said, noting that one man who died in November was prescribed 2,087 pills in the six weeks before he died.

In addition, two women taken to a hospital emergency room indicated they were among numerous people who used sex to pay Diaz for narcotics, according to an affidavit filed in the case.

Court records and interviews show authorities had Diaz on their radar but his medical license remained in good standing. In fact, complaints about Diaz date back roughly 15 years, and doctors reached out to the DEA about four years ago. Dr. Chris Lambert, an emergency physician at Cottage Health System was one of the doctors to flag Diaz's prescribing patterns. DEA spokeswoman Sarah Pullen said the investigation into Diaz began in mid-2009, but she was unaware of any prior complaints against him.

People traveled hundreds of miles to see Diaz, who specialized in pathology and geriatrics at his Santa Barbara office. Lambert estimated that between 2009 and 2010, the hospital reported more than 400 emergency room visits by patients of Diaz. Two were 96 and 100 and had been provided with significant amounts of narcotics, he said.

In another case, a fellow doctor told authorities that a patient of Diaz had received enough Dilaudid "to kill a horse," according to court documents.

Santa Barbara police interviewed Diaz in late 2007 in connection with the overdose death of a 53-year-old woman, and the physician said he hadn't seen the woman in a month and had been treating her for arthritis and hypertension, according to court documents. The woman's daughter was later interviewed and believed her mother had been overmedicated.

In October 2009, Lambert and other doctors notified the state medical board that the hospital where they worked was admitting at least one of Diaz's patients a month who had been prescribed high doses of narcotics. They never heard back from the board, he said.

Diaz "would always say there was a legitimate reason for them to have high doses of narcotics, which was hard for us to believe," Lambert said.

Dan Wood, a medical board spokesman, said the agency is aware of the allegations against Diaz but couldn't confirm or deny that an investigation was under way. Asked if the board was slow to respond to the Diaz accusations, he declined to comment.

Among those who died: A 49-year-old father who overdosed on painkillers after recently completing a 60-day drug rehab; a 35-year-old mother found dead in her bedroom by her young daughter, who was hosting a friend for a sleepover; an out-of-work county bus driver who overdosed on painkillers and other drugs as she grew increasingly depressed over the upcoming anniversary of her 20-year-old son's overdose death, which she attributed to her son taking painkillers that Diaz had prescribed to her.

Diaz, who could face up to 20 years in prison if convicted, told the Los Angeles Times, "perhaps there were some hints there that I should have known they were going to overdose." He added that even in some cases in which he suspected a patient was abusing drugs, he would continue prescribing so that he could manage what they were taking.

"If you don't give them the medications, they are going to go to the street," he told the Times. "That has become an issue of: What is the worse of two evils?"

I know "which is the worse of two evils." A physician who has no ethics and who doesn't adhere to a Hippocratic Oath is pure evil with the blackest of hearts and the most corrupt of minds. The callous medical monster distorts and abuses the Code of Ethics in the name of "relieving pain and suffering." Greed and immoral behaviors fuel the toxic mix that kills countless thousands directly and destroys untold millions indirectly.

In the names of Hippocrates and God Almighty, I call upon all those families who have lost loved ones to these imposters and their deadly practices. Please --

Do everything you, 
the loving family,
possibly can
to separate these 
"professional" serial killers 
from every cent they still possess
as they spend the rest of their lives
in a prison where they daily reap 
the horrible consequences of the unethical. 
Separation from money 
is the "silver bullet" 
that kills their filthy souls.

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