Doctors shall not kill

[Den svenska versionen här]

Background:

At the Astrid Lindgren Children’s Hospital – located in the compounds of the Karolinska University Hospital in Stockholm –  a sick three-month baby girl dies under unclear or disputed circumstances. She was in a respirator which was terminated when tests showed significant deterioration. The girl was administrated palliative medication by the doctor and died after five hours in the arms of her parents. During autopsy it was found, however, high doses of morphine and thiopental sodium.  The Office of the Swedish Prosecutor initiated an investigation and the case is now under trial at the court. The doctor, an operation anaesthesiologist which according to Aftonbladet had served in international operation scenarios such as under the Gulf War, is accused of given the girl the thiopental sodium which apparently killed her. The doctor denies. As soon as the investigation of the case became known in the media, so did loud protests from the Swedish Medical Association. Marie Wedin,  President of the Medical Association, declared today that doctors are very “worried” about what will be the outcome of this trial (SvD 13 September 2011). The Medical Association and diverse euthanasia-advocates have managed to present the case as if the doctors, and particularly the accused, would be the “victims”.  Previously protests have even referred to “violation of professional integrity of doctors” and a supposedly inviolability of their professional rights or clinical assessments. The prosecutors on their part defended the prosecutor. The Professors blogg has analysed the case from a societal perspective, and concluded among other:


That a doctor, or a prosecutor, or a professor, would have their feelings hurt by a questioning from the media, the public, on in certain cases from the law, is totally irrelevant. The public  does not support our comfortable incomes for us having an uncontested, arbitrary professional conduct deprived of criticism. It is not that the public, the patients, do exists to legitimate our professional or private existence. It is the other way around. We receive trust and get good pay from society to serve society and its citizens, not our collegial egos, or private interests.
 
Professor Madeleine Leijonhufvud argues the following in her article “indictment of the pediatrician has no basis in criminal law (in Swedish)” published in the leading Swedish newspaper Dagens Nyheter ‘”(09/12 2011):    


“In healthcare of the assignment is to heal, if you can not cure you should alleviate [symptoms], if you can not alleviate you should give consolation.”  

What?  

And, if healthcare cannot accomplish the above, would the doctors kill instead? Who would obtain consolation of that, really?  

As a temporary response to Professor Lejonhufvud, I give here anew my arguments as presented in “Doctors are to serve the nation and the patients. Not the other way around” (in Swedish).

Based on the public interest, an imperative that should be clarified around the events at Astrid Lindgren Children’s Hospital – in particular the medical establishment’s attitude toward the legal prosecution of a doctor accused of ending the life of a newly born child – is:  The Society, with their public funds, finance hospital and pay doctors not primarily to protect doctors delicate professional or private integrity. Particularly, the aim shall never be to protect doctors at the expense of justice for all, inclusive patients and their significant others. What society expects instead is that doctors shall do their job in the patient’s survival interest. And this should be done, with ethics, professionally – and under the rule of law.  


The return to Warland. Detail. Ferrada de Noli 2004

In the debate article Restraint can create unnecessary suffering, published by Svenska Dagbladet, Professor Daniel Tarschyso – the Chairman of the Working Group within the National Council on Medical Ethics – lamented himself  that
“Both among physicians and prosecutors, the prevailing feeling now is that their professional integrity has been now challenged.”  

Here below some reflections about that statement. Let me just first put forward this following strange paradox, which habits deeply and sincerely in the core of the Swedish political culture.  

On the one hand in Sweden it is generally considered both rude and pointless to held public officials “accountable” for their actions (“to public answer for one’s actions, it is called). Note that the noun used in Sweden in these contexts is “to answer” instead of “take responsibility.”

Many laws are seemingly devised more to excuse the authorities’ actions than to examine their deeds, their power, and their arrogance.  

In the above sentence I include in authorities – view from the public – the Swedish medical profession, police, et cetera.  

And on the other hand, at every opportunity in which a scandalous act committed by any member of such authorities is made public by the media, those collegial institutions in which the officer (doctor, prosecutor, etc.) belongs

A. In the first place they react as a body in defending the accused which belongs to their ranks. 

B. In the second place they never refer in such defense  to social consequences that the eventual behavior have, or the consequences for the individual/s affected. Instead, their public declarations will always refer to the “deplorable human circumstances” occasioned to the officer by the public accusations. Concretely, the affective, emotional or physical consequences that the publication of the incident have brought for the accused.  In the words of my old Logic teacher, purely “fallacy ad misericordiam”.

As the readers would have noticed, the above has nothing to do with “public service”. The above is instead pure cool, egocentric, professional-cultural behavior.  

From the perspective of the public interest, the citizens as a whole, the problem is not (“primarily” or other wise) that a certain doctor or prosecutor, or politician, is “feeling that their professional integrity has been now challenged” (!)

From the perspective of the public interest, the citizens as a whole, the problem is that the life of a person, a human, however “small” that life was, may have run out on the cause of homicide or a wrong act, intentionally produced or not.  

That a doctor or a prosecutor or a professor would have their feelings hurt by a questioning from the media, the public, on in certain cases the law, is totally irrelevant. The public  does not support our comfortable incomes for us having an uncontested, arbitrary professional conduct deprived of criticism. It is not that the public, the patients, do exists to legitimate our professional or private existence. It is the other way around. We receive trust and get good pay from society to serve society, not our collegial egos, or private interests.

And in the background of this discussion we have the real discussion, theme of euthanasia and doctors assisted death. 



Marcello Ferrada-Noli

 





 
 

 

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