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Ethics Not Always that Complicated

By Paul S. Kock, M.D.

Ours is a tiny and quirky little state, where almost everyone knows somebody doing time in the can for one indiscretion or another, and for the most part it's not held against them. "Johnny pleaded nolo and got 24 months." "Not bad. He'll be out in 8 and still make Ronnie's wedding. Will he want chicken or steak?" Johnny would be called "friend" prior to conviction; "This guy I know" while away.

With that as a prelude, this month I want to discuss some issues in medical ethics. Often, deciding the ethical course is easy; sometimes it is not easy; and sometimes it boils down to simply what is appropriate and legal.

This guy I know served on several medical boards with me, including a long stint on the state's peer review board. He practiced in the worst part of town, seeing mostly patients on welfare. He was given tons of drug samples, which many of his poor patients did not need because they had full prescription coverage from the state. So, to supplement his income, he sold these samples to a local pharmacist who dispensed them along with his regular stock. In 2 years he sold more than a quarter-million pills.

"What's the harm?" you might ask, and you might think him a bit clever. But remember that many samples are given out close to expiration. Once mixed with other stock, there is no way to be sure a patient is receiving a pill of proper potency. That's inappropriate. It's unethical. Unfortunately for this guy I know, it also violates anti-drug-tampering laws. That's illegal.

Unfortunately for his patients, there was more. We learned at trial that he used a full-strength solution to vaccinate his American patients, but a watered-down vaccine for his immigrant children. No question about that one, inappropriate, unethical and illegal. His office is closed now because he is spending the next 10 years, maybe only 3 with good behavior, as a guest of the state.

What I Tell My Teenage Son

Sometimes, medical ethics is easy: "Do right; don't do wrong." Sometimes it is not so easy, and that is why we have advisers and oversight committees. Sometimes ethics is maintained by simply following the law, and ethics violations can be avoided by heeding the double-negative caution I give my teenage son and his friends: "Don't do stuff that the cops won't like." I guess this guy I know didn't know that.