Map of life expectancy at birth from Global Education Project.

Friday, July 06, 2007

A possible breach of medical ethics?

It's been fascinating hearing the chatter about the "Doctors' plot" terrorism case in the UK. Much punditry has focused on the cruel irony that people who have taken an oath to do no harm would be involved in such heinous acts.

Actually "do no harm" is not in the Hippocratic oath (and Cervantes busts another myth), but it would seem to be the case that attempting mass murder is inconsistent with our expectations of physicians. Alas, although I cannot say whether physicians are more likely to become mass murderers than, say, welders or medical sociologists, they are definitely likely to get away with it, and what is most notable about some of those who have been caught is the impressive totals they managed to run up before the murder did out. The Jihadi sawbones are probably most noteworthy for their incompetence, not their intentions.

The weirdest of my punditry experiences was listening to a discussion on the BBC about how appalling this all was and couldn't the National Health Service do something to screen out doctors who might be evil and so forth? This lengthy conversation managed to assiduously avoid the very recent, very notorious, and presumably highly relevant case of Harold Shipman, M.D., a veddy veddy British gentleman who murdered at least 150 of his patients and probably closer to 300. He never confessed and we don't know his motives but evidently he just enjoyed it for some reason.

Then there was Michael Swango, an American physician addicted to poisoning his patients. He also tried to poison some of his coworkers, and was caught at it -- yet he was permitted to continue practicing medicine.

Kenneth Iserson, M.D., has compiled stories of several physician mass murderers. Again, what they tend to have in common is an extraordinary ability to get away with it, because of relevant skill and guile, assisted by physicians' high social status and cultural reluctance to question their judgment and actions. A couple of these cases are of doctors who were carrying out the policies of depraved political leadership, in Iserson's book the grotesque human experiments conducted in imperial Japan, and of course the comparable Nazi experiments are somewhat better known in the U.S. (I'm not sure why.) But that's a somewhat different case.

Please do not become paranoid. Such anti-doctors are, of course, one in a million. Most of the docs I know really, deeply, sincerely care about their patients and want to honor their profession. The worst of them really, deeply, sincerely care about money and want to be rich and adored, but murdering people is generally not conducive to those goals.

What is particularly noteworthy about the UK terrorist docs is that, in spite of their evident hatred for Britons in the collective and abstract, and their indifference to human life, there is no indication, at least so far, that they did not practice medicine in an exemplary manner. If killing people was what it was all about, they could have emulated Dr. Shipman and done it quietly for years. But that, obviously, it is not the point of so-called terrorism, which is a public action intended to draw maximum attention. Murder is just a means to that end, and it wouldn't surprise me if, in their professional lives, they would have found the idea of harming patients appalling and impossible. Humans are weird, that's for sure.