Opinion | Ethical Lapses in the Medical Profession

To the Editor:

Re “Moral Dilemmas in Medical Care” (Opinion guest essay, May 8):

It is unsettling, and dismaying, to read Dr. Carl Elliott’s account of moral lapses continuing to exist, if not thrive, in medical education. As a neurology resident in the early 1970s, I was assigned a patient who was scheduled to have psychosurgery.

He was a prisoner who had murdered a nurse in a hospital basement, and the surgery to remove part of his brain was considered by the department to be a therapeutic and even forward-looking procedure. This was despite its being widely discredited, and involving a prisoner who could not provide truly informed consent.

A fellow resident and I knew that refusing would almost certainly result in suspension or dismissal from the residency, so we anonymously contacted our local newspapers, whose reporting resulted in an overflow protest meeting, cancellation of the psychosurgery and legislative action placing conditions on the acceptance of informed consent by prisoners.

It is lamentable that even though bioethics programs are widely incorporated into medical education, moral and ethical transgressions remain a stubborn problem as part of medical structures’ groupthink.

As Richard Feynman has emphasized, doubt, uncertainty and continued questioning are the hallmarks of scientific endeavor. They need to be an integral element of medical education to better prepare young doctors for the inevitable moral challenges that lie ahead.

Robert Hausner
Mill Valley, Calif.

To the Editor:

I would like to thank Carl Elliott for exposing the “Moral Dilemmas in Medical Care.” There is a medical school culture that favors doctors as privileged persons over patients.

I can remember multiple patient interactions in medical school in which I thanked a patient for allowing me to examine them and apologized for hurting them during my exam of their painful conditions.

I was then criticized by attending physicians for apologizing to the patients. I was told, on multiple occasions, that the patient should be thanking me for the privilege of assisting in my education.

Medical training, in a medical school culture that favors the privilege of the medical staff over the rights and feelings of patients, needs to be exposed and changed.

Doug Pasto-Crosby
Nashville
The writer is a retired emergency room physician.

To the Editor:

As a psychiatrist and medical ethicist, I commend Dr. Carl Elliott for calling attention to several egregious violations of medical ethics, including failure to obtain the patient’s informed consent. Dr. Elliott could have included a discussion of physician-assisted suicide and the slippery slope of eligibility for this procedure, as my colleagues and I recently discussed in Psychiatric Times.

For example, as reported in The Journal of Eating Disorders, three patients with the eating disorder anorexia nervosa were prescribed lethal medication under Colorado’s End-of-Life Options Act. Because of the near-delusional cognitive distortions present in severe anorexia nervosa, it is extremely doubtful that afflicted patients can give truly informed consent to physician-assisted suicide. Worse still, under Colorado law, such patients are not required to avail themselves of accepted treatments for anorexia nervosa before prescription of the lethal drugs.

Tragically, what Dr. Elliott calls “the culture of medicine” has become increasingly desensitized to physician-assisted suicide, nowadays touted as just another form of medical care. In the anorexia cases cited, informed consent may have been one casualty of this cultural shift.

Ronald W. Pies
Lexington, Mass.
The writer is on the faculty of SUNY Upstate Medical University and Tufts University School of Medicine, but the views expressed are his own.

To the Editor:

Carl Elliot’s article on medical ethics was excellent. But it is not just in the medical profession that there exists the “subtle danger” that assimilation into an organization will teach you to no longer recognize what is horrible.

Businesses too have a culture that can “transform your sensibility.” In many industries executives check their consciences at the office door each morning. For example, they promote cigarettes; they forget they too breathe the air as they lobby against clean-air policies; they forget they too have children or grandchildren as they fight climate-friendly policies or resist gun-control measures. The list could go on.

In every organization, we need individuals to say no to policies and actions that may benefit the organization but are harmful, even destructive, to broader society.

Colin Day
Ann Arbor, Mich.

Don’t Cave, Columbia

To the Editor:

Re “Columbia’s Protests Also Bring Pressure From a Private Donor” (front page, May 11):

Universities are meant to be institutions of higher learning, research and service to the community. They are not items on an auction block to be sold to the highest bidder.

Universities that sell off their policy platform to spoiled one-issue donors who threaten to throw a tantrum no longer deserve our respect. Grant-making foundations should not be grandstanding online. Give money, or don’t, but don’t call a news conference about it.

If Columbia caves, why should prospective students trust it as a place where they can go to become freethinkers and explore their own political conscience as they begin to contemplate the wider world and issues of social justice?

This is a real test of Columbia and its leadership. I do not envy its president, Nemat Shafik, who has few good choices and no way to make everyone happy. What she should not sell is her integrity, or the university’s. She should stand up to these selfish donors. Learn to say, “Thanks, but no thanks.”

Carl Henn
Marathon, Texas

A Florida Book Oasis

To the Editor:

Re “Book Bans? So Open a Bookstore” (Arts, May 13):

Deep respect for the American novelist Lauren Groff and her husband, Clay Kallman, for opening the Lynx, their new bookstore in Gainesville, Fla. The store focuses on offering titles among the more than 5,100 books that were banned in Florida schools from July 2021 through December 2023.

To all the book clubbers and haters of bans: Order straight from the Lynx.

Fight evil. Read books.

Ted Gallagher
New York

To the Editor:

Re “Keep a Firm Grip on Those Mickey Mouse Balloons. It’s the Law” (front page, May 9):

Balloons are some of the deadliest ocean trash for wildlife, as mentioned in your article about Florida’s expected balloon release ban.

Plastic balloon debris poses a significant threat to marine life, often mistaken for food or becoming entangled in marine habitats, leading to devastating consequences for our fragile ocean ecosystems.

As the founder of Clean Miami Beach, an environmental conservation organization, I’m concerned about the impact of plastic pollution on Florida’s wildlife and coastal areas. Florida’s stunning beaches and diverse marine life are not only treasures to us locals but also draw millions of tourists each year.

Because of the dangers, intentional balloon releases have been banned in many cities and counties across the state. A poll released by Oceana showed that 87 percent of Florida voters support local, state and national policies that reduce single-use plastic. Gov. Ron DeSantis must waste no time in signing this important piece of legislation into law.

Our elected officials should continue to work together to address environmental issues so Floridians and tourists can enjoy our beautiful state without its being marred by plastic pollution.

Sophie Ringel
Miami Beach