The NC Legislature Confronts (Not) The Complexities of Medical Ethics

Like I said, I got distracted by my little foray into Sue's world, but that foray has helped emphasize how little the lay public actually knows about the ethical dilemas physicians face every day . . . not to mention the "advocacy organizations" (like the AMA and state medical societies) whose public face differs mightily from what they show to those they're supposed to represent.

And here's another example (I missed the story when it first came out - but got caught up via Carolina Online).

The North Carolina Legislature's "first foray" into the debate over putting a physician in the middle of executions includes a bill filed by Senator Phil Berger (R-Guilford/Rockingham), a death penalty supporter, that would protect any medical professional from punishment by a state board for participating in a lawful execution.

"It seemed to me that, if in fact the procedure that was adopted (by the council) does run afoul of the ethics board, that this would be a way to address that issue," he said. "Even if the new protocol is accepted (by the Medical Board), there's always a possibility that in the future some other Superior Court judge will have an issue with it."

In other words, let the North Carolina legislature make an end run around the ethical issue. Every medical and nursing organization under the sun (the NC Nurses Association weighed in this week) is telling you that putting medical professionals in the middle of the execution process is fundamentally wrong.

But hey, let's put them in the middle anyway!

Senator Berger just doesn't get it.

In contrast to Senator Berger's smooth move, Sen. Ellie Kinnaird (D-Orange/Person) has also filed a bill calling for a study commission on lethal injection and a moratorium on executions until June 1, 2009.

It's discussion should cover not just a doctor's potential role but that of any medical professional, Kinnaird said after filing the bill Wednesday.

"I think it's important for us to discuss this in the context of professional codes of ethics," she said. "And that means not only doctors, but also nurses and pharmacists — should they be producing the chemicals that kill people? I think it means EMT people. I think it means anybody."

Respectfully, the pharmacy thing is a big leap. The "chemicals that kill people" (also called drugs) are already being made and will continue to be made. They're used every day in fashions that do not kill people. But apart from that, Senator Kinnaird demonstrates she is thinking very clearly about the issue at hand.

Of course, cutting to the chase, the contortions legislators are doing around one ethical issue (a doctor's presence at an execution) lifts the lid on the bigger ethical can of worms . . . whether or not death penalty should exist at all in North Carolina. And in the end, this is the issue that all of the contortionists are gunning for . . . or trying to keep carved in stone.

Quagmires involving medical ethics do not get their due from the state. For example, in the last few weeks, I've sent two sets of e-mails to the entire NC Legislature about my own situation . . . a professional quagmire created when I adhered to ethical cannons established by the NC Medical Board in the face of threats and coercion on the part of "non-profit" Randolph Hospital officials.

I've gotten a few phone calls from representatives who took the time to read beyond the first few paragraphs (the fact that I was fired for saving a child's life seems to be the big "hook" in the story), but my biggest problem seems to be the very short attention span of anyone in government. If something cannot be explained in 100 words or less, nobody has the time or inclination to delve further.

One legislator helpfully (not) offered that, "Perhaps this is a matter for the courts?".

Exactly my point. Criminal court. Hello Garland Yates.

It's a lot like what I have encountered from the journalists who play in our local blogosphere (see my profile . . . drafted for the benefit of folks like Edward Cone and John Robinson).

Randolph Hospital officials have always counted on this kind of thing to obscure their deeds. While I flounder, lost in the ethical and legal complexities that led up to their perjury & contempt (criminally speaking, now a relatively simple & straightforward charge), they can tell their good buddies in DA's office . . . or their contacts in Raleigh that I'm just a "disgruntled employee" or (worse) a "whack-job".

As I have blogged before, in 2002, after the lawsuits with Randolph were "settled", I was appointed as a physician representative to a joint NC Medical Society/NC Hospital Association "Peer Review Task Force". In retrospect, the NCMS was just throwing me crumbs . . . after three years of telling me that they could not help legally me (apart from waiving one year's membership fee). I was fired, locally black-balled, and sued (among a host of smaller professional humiliations) for doing the absolutely right/moral/ethical thing and reporting what happened to hospital peer review.

But the NCMS and NCPS and mighty AMA stood on the sidelines and watched . . . deaf, dumb and mute.

The Peer Review task force met FIVE YEARS ago. We talked about "bad-faith medical peer review" and the difficulites employed physicians (particularly young doctors/minority doctors/doctors in public service) can face in the corporatized world. But the meetings were for naught. The recommendations coming out of those meetings (addressing little matters like due process in any disciplinary action) were ultimately torpedoed by the NC Hospital Association's refusal to accept them as anything more than suggestions.

Could that be because the NC Hospital Association KNOWS there are BIG problems . . . and that a lot of NC doctors would/could come out of the woodwork with a lot of ugly accusations?

Despite doctor shortages looming in the near future, in the five years since the task force meetings fizzled into a whole lot of nothing, the NC Medical Society has DONE NOTHING to enact ANY KIND of peer review reform . . . or take measures to offer more protections to employed physicians in this "right-to-work" state.

Contrary to popular belief, whistleblower protection exists in a complex muddle of state and federal jurisdictions . . . that few lawyers have the knowledge to navigate on behalf of doctors . . . and few physicians have enough money/resources to pay them to wade through. And let's be perfectly clear, the individual physician will NOT get any help with that from the NC Medical Society.

The truth is, the state actually wants the individual doctor wronged to "just go away". We simply cannot embarrass our hospitals. I guess the bureaucrats and businessmen (battling for "market share") think patients have tons of choices of where to go when they're really sick.

Last year, I sat through a NCMS "physician forum" in Wilmington where an obviously drunk legislator lectured a room FULL of frustrated physicians on the real meaning of "getting involved" in politics: Give them money and they'll pay attention . . . otherwise you're SOL.

The NC Medical Board, in fact, has compounded the problem of bad-faith review by pushing through a new law (last year) that allows anonymous complainants/experts to stand unchallenged against physicians in its review process. A physician under review (sometimes for nebulous accusations like being "disruptive") does not have the right to confront his/her accuser. Please tell me, in what other court proceding . . . against any other citizen apart than a physician . . . where property rights (in a doctor's case, a medical license or hospital privileges) are at stake . . . would that be considered "constitutional"?

Here's the thing: The NC Legislature is very worried about whether a condemned murderer "suffers" the least little bit when he/she is executed. As it stands now, some bureaucrats are ready to go to the mat in order to ensure that someone is killed "constitutionally" . . . even if it puts a doctor in the middle of something the medical profession deems unethical.

But upholding the civil and constitutional rights of a doctor who stuck to her ethical guns and did her licensed duty (to the public that the Medical Board and Legislature says it serves) is barely a serious consideration . . . buried by the Courts and law enforcement.

Over and over again, our leaders have proven they cannot deal with the complex.

What they don't seem to get is, that if they sat down and dealt with the complex before they filed the bills and passed the laws, they might not have so many problems.

Oh, and if they insisted that the laws we already have were enforced . . .