Celebrity Pathology Requires Ethics To Treat

Am I a Brit-snob?  Never thought I was, but maybe I am turning into one. Or maybe it is because The Daily Mail has more detail about the trial of Michael Jackson’s doctor — and better pictures. Whatever.  The truth of the matter is that when the story about Michael Jackson’s death first came out, I had to look up the generic name of Propofol, because I have never used it.  I mean, why would I be hanging around with general anesthesia?  For that matter, why would a cardiologist be hanging around with general anesthesia?? Money alone?  Possible, I do not know what this guy’s finances were like. But I have never personally known or heard of a starving cardiologist — although I suspect that those who do insurance only no co-pay may be closer to it than they want to admit.  But I suspect this guy was not one of those. “Rescuer?”  Perhaps.  Although I cannot quite see Michael Jackson as a “victim” needing saving. Someone basking in the glare of celebrity?  More likely.  A rich person’s doctor, maybe — a doctor wanting to work with famous people. I have felt the pull of that one myself.  But I ran like crazy when I figured out these folks are more interested in getting the prescriptions they want – usually recreationally — rather than in getting something that might actually help any actual medical problem they might have. “Celebrity” may be a new kind of pathology, where people imagine themselves as uber-people who have more rights than other people, and who can buy pretty much anything they want.  Some doctors are easier to buy than others –otherwise how could tobacco companies present medical experts who say smoking won’t harm you? Who can put a price on credentials, or even signatures?  I think this man sold it all. Sure, The Mail has verified — other stories, other places, too — that his purchase of large amounts of propofol was legal, and that his credentials were real. This is not substitute for “ethics,” which people often say they will teach in medical school, but which are, basically, impossible to teach. How can you teach something that life-experience will be the only thing to test you on? Ethics are learned young, far before medical school, and internalized.

People should have some kind of a moral governor.  Unfortunately, the assumption in this country is that it comes from religion — which it does not always. Me, I was treated to imprinting with parental lectures on why it was important to be good. Readings from the front of the prayerbook while waiting for temple services to start may have been a really powerful adjunct. But it was internalized, long before I started school, that GOOD was the thing to be, and that someone would always be watching.  Yes, all right, they talked about God to me, my parents did.  Nothing detailed, just the need to be good. For a mature adult one would hope that the inclination to be good was not necessarily just a fear of punishment, but some higher ideal.

Especially  for a physician, who at some point was supposed to take an oath to respect a higher power.

I did, by choice.  In France the Hippocratic Oath was not required of foreigners, but I loved it and wanted it so I took it. Of course everyone who knew me well knew I believed in abortion so they dropped that sentence on my copy.

Because it had to be real. Everything about it had to be real. Now the only time I hear talk about being real is in Alcoholics Anonymous meetings.  And the people who say it are sometimes not real. No, I am not going to cry about missing that old time religion.  It is not that. The defense against hypocrisy in our nation is thin.  In my profession it is at least as bad. It may have been legal to “get” anesthesia.  It cannot have been ethical to treat an addict to a drug normally used only in an operating room under the monitoring of several doctors and nurses, obviously with potentially fatal capabilities, to use alone in his home, with no more than cursory monitoring from all I can figure. I am not sure how to get people to do the right thing, except, maybe, if they start very young.