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Ethics Anyone?

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Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6800 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6800 followers on Twitter.

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An emergency department of a hospital in Tennessee performed some highly questionable acts on a prisoner. Do you think an ethical boundary was crossed?
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Is it OK for a doctor to give a prisoner medications to induce paralysis, intubate his airway, place him on a ventilator, and perform a rectal examination to look for drugs?

Is it OK to threaten a prisoner with the above actions in order to persuade him to consent to a rectal examination?

Without a court order, is it OK for a doctor to do a rectal examination on a prisoner who does not consent?

In the emergency department of a hospital in Tennessee the answer to all three of the above questions was “yes.”

But a ruling by a US Court of Appeals overturned the man’s conviction for possession of crack cocaine with intent to sell because the acts of “paralysis, intubation, and rectal examination” were in clear violation of [his] Fourth Amendment rights. (page 18 of the ruling).

The Fourth Amendment prohibits unreasonable searches, and warrants must be based on probable cause.

A lawyer representing the police blamed it all on the doctor, but the court ruled that he was “a tool” used by the police to search the man.

One article said the doctor, an emergency medicine specialist, testified as follows, “That exam was going to occur with or without his consent.”

At least one other victim, a man who was threatened with paralysis by the same doctor and consented to the search, has filed suit against the police. No drugs were found on that occasion.

There was no emergency in either situation. There was plenty of time to obtain a warrant. Other options such as a plain x-ray of the abdomen and pelvis, could have been pursued. If drugs were present, they would have been passed eventually, or the prisoner would have become so uncomfortable that he would have requested their removal.

Paralyzing and intubating someone’s airway is not a simple procedure.

Serious complications can occur, such as perforation of the pharynx, trachea, or esophagus leading to an abscess, vomiting and aspiration of stomach contents into the lungs, inability to place the tube in the trachea, inadvertent intubation of the esophagus, and accidental dislodgement of the tube.

Many of these complications could result in decreased oxygenation of vital tissues and if not immediately corrected, even death.

Do you think these risks were explained to the prisoners?

I suppose this is an understatement, but in addition to the legal issues, I think an ethical boundary may have been crossed here.

What do you think?

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6800 followers on Twitter.

7 Comments

  1. In 1947 After the Nuremberg trial of the Nazi doctors, the Nuremberg code emerged for protection of human subjects in research.
    In 1981 the Department of Health and Human Services made significant revisions to the human subjects protections regulations, and one of the 5 parts of the 45 CFR 46 is specially dedicated to the protection of prisoners.
    With the advent of private jails and prisons, it is possible that we may see the physicians who work in the system to be obligated to do this very unethical moves.
    With the privatization of jails, society is paying huge prices to encarcerate individuals that should/ could be placed in a different rehabilitation centers, at much cheaper cost to society and to the individuals.

    Reply
    • In some ways, prisoners have more rights than those at large. It is nearly impossible to do research on prisoners since they are in a position of susceptibility to coercion. Coercion clearly occurred in both the cases that I wrote about.

      Reply
  2. That physician was a tool alright. You are correct, searches require warrants or imminent danger. Stating the search would happen one way or the other just demonstrates a complete disregard for the law. I don’t think that physician has ethical boundaries, or they are so far removed he hasn’t seen them in some time. I imagine he’s one of those people who is just a constant delight. Oops, let me get a towel to mop up all that sarcasm!

    Reply
    • Thanks for picking up that “tool” reference. I left it for you. Wasn’t that nice of me?

      Reply
      • …and I like you for that!

        Reply
  3. OMG! Sounds like Medieval Medicine. Humane boundaries were crossed, not just ethical boundaries. This is immoral assault.

    Reply
    • It’s hard to argue with your point.

      Reply

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