USA POLITICS: Military Medical Ethics and Dr. Conley’s Misrepresentations of the President’s Health – opinion

Brig. Gen. (Ret.) Stephen N. Xenakis, MD and Jonathan Moreno | Just Security

WHAT IS IT ABOUT THE SYMBOLIC POWER OF A LAB COAT? In 1961, the sociologist Howard Becker titled his great book about the transition from medical student to physician Boys in White. Also, around that time the psychologist Stanley Milgram found that some ordinary people were willing to impose pain on strangers at the command of a scientist in a lab coat.

The “white lab coat” symbolizes the unique role that we bestow on members of the medical profession. By standing at the platform in a white coat, the physician to the President, Dr. Sean Conley, and his colleagues leveraged the special trust and confidence that societies endow to their healers.         

Truth telling wasn’t traditionally part of that role. Historically doctors routinely lied or at least concealed the truth from patients, concerned about overburdening them with bad news that no one wants to tell. Dressed up in fancy terms like “therapeutic privilege”, that began to change in the 1960s. Now patients expect their doctors to tell them what’s ailing them and even to participate in their medical decisions with informed consent.

Today’s patients rely on their physicians to be truthful and professional in carrying out their duties and responsibilities. Those ethical standards apply to military physicians as well. Military commanders depend on the truthfulness and professionalism of their physicians to advise them in making critical decisions, such as authorizing a pilot to get back into the cockpit, deeming a soldier to be fit to deploy, allowing an officer to stay in command, etc. For the commanders to sustain confidence in the advice of their physicians, they must trust that their doctors unfailingly exercise the courage to provide unvarnished truth. To witness military physicians bending or burying the truth does long-lasting damage to the confidence required for the system to work. 

Doctors taking care of powerful leaders have long engaged in cover-ups, including in service of democratically elected heads of state as well as dictators. In the days of a tightly controlled press that wasn’t difficult. But in our time the failure to extend truth telling about their leaders to the general public was blindingly clear in Dr. Conley’s obvious prevarications in his updates on the president’s medical condition.

BOUND BY THE RULES OF PRIVACY EMBODIED IN THE LAW, DR. CONLEY COULD DISCLOSE ONLY THE INFORMATION THAT THE PRESIDENT HAD EXPRESSLY AUTHORIZED — NOTHING MORE, AND NOTHING LESS. FAIR ENOUGH.

BUT HE WENT FURTHER. Dr CONLEY INTENTIONALLY AND KNOWINGLY MISREPRESENTED THE PRESIDENT’S HEALTH AND TREATMENT. 

One interpretation of Dr. Conley’s rationale for some of his misstatements has been to paint a rosier picture for the president himself, perhaps to reassure him about his prognosis. If so, that would be an invocation of the outdated therapeutic exception and might have given his patient false reassurance. Or perhaps Dr. Conley was obfuscating for another audience: The American public. IN EITHER CASE HIS DECISION CANNOT BE JUSTIFIED. 

THIS EPISODE HAS ILLUSTRATED HOW TIMES AND PUBLIC EXPECTATIONS HAVE CHANGED. When a doctor speaks to American people about the condition of a leader, that physician functions as a crucial membrane in that public’s understanding about the stability of their government. The polity’s expectations are and ought to be different than they were even a few years ago. Dr. Conley was obligated to object to any order to knowingly deceive the public about the President’s medical condition. 

That principle must become part of an explicit standard of ethics for the next physician in the position of Dr. Conley and his white coat. 

Post a comment or leave a trackback: Trackback URL.

Comments

  • Clyde Duncan  On October 9, 2020 at 6:50 pm

    THE COMPLICIT PHYSICIAN

    Americans need the bare truth from Trump’s doctor, not empty reassurances.

    Dr. James Hamblin | The Atlantic

    FOR THE PAST SEVERAL DAYS, PRESIDENT DONALD TRUMP HAS HAD COVID-19. It is unclear for how many days, because the president’s physician, Sean Conley, refuses to share that information. When asked again yesterday, Conley told reporters, “I don’t want to move backwards.” In fact, Conley has shared very little about the course of the president’s illness.

    THE UNIQUE BIOETHICAL DILEMMA OF THE MOMENT IS THAT WE ARE IN THE MIDDLE OF A PANDEMIC.

    Accepting reality, and a shared set of facts, is vital. And there is one crucial exception to a doctor’s obligation to protect a patient’s privacy: WHEN THAT PATIENT IS A THREAT TO OTHERS.

    Conley even defended the president’s decision on Sunday to break quarantine and go on a car ride with Secret Service agents, which an attending physician at Walter Reed called “insanity”. At the very least, the appropriate response from Conley would have been to say “I advised against that”.

    STATISTICALLY, TRUMP IS MOST LIKELY TO CONTINUE RECOVERING UNEVENTFULLY. This decision to return home is not clearly medically unwise for him. But the declaration of victory and the overall downplaying of Trump’s medical status do a grave disservice to the public. And though it is within Trump’s purview, going back home is, at the very least, INCONSIDERATE OF THE STAFF AT THE WHITE HOUSE.

    That creates risk not just for those who work there, but everyone who has contact with those people, and then everyone who has contact with those people. As the current cluster at the White House has made abundantly clear, a single negligent act can end up leading to multiple cases.

    SUCH ACTS ARE PREVENTABLE. Most happen because of failures to take basic precautionary measures. Since the beginning of the pandemic, Trump has repeatedly failed to take such measures, and he continues to dismiss the threat, denying simple facts and implying that some form of exceptionalism will exempt Americans from suffering.

    MEANWHILE, MORE THAN 200,000 AMERICANS HAVE DIED FROM COVID-19. Conley has had ample opportunities to do what Trump has NOT done — speak objectively about the medical facts. Simply doing so would emphasize the importance of wearing masks and taking the virus seriously.

    INSTEAD, CONLEY HAS OPTED FOR COMPLICITY, becoming a mouthpiece for Trump’s show of personal strength. Americans are left to speculate about Trump’s health based on what they see in curated videos and press photos — none of which show him in a hospital gown or even in a medical setting.

    IN ANOTHER TIME AND PLACE, IT MAY BE FINE TO RESPECT A PRESIDENT’S PRIVACY REGARDING MEDICAL ISSUES THAT HAVE NO BEARING ON ABILITY TO GOVERN.

    But downplaying Trump’s case of COVID-19 in this unique moment has widespread consequences. The hundreds of millions of Americans who are still at risk of contracting this disease could have seen the realities of what it is like, and better understood the value of stopping the virus.

    INSTEAD, THEY HAVE BEEN SHOWN THAT THE CONSEQUENCES OF NEGLIGENCE ARE CINEMATIC HELICOPTER RIDES; A DRIVE-BY WITH SECRET SERVICE AGENTS – AT RISK AND A WEEKEND SPENT WEARING A SUIT IN THE HOSPITAL.

  • Clyde Duncan  On October 11, 2020 at 1:08 am

    Opinion | Want to Know How the Trump Story Ends? READ EXODUS

    The Pharaoh of 2020 America, always so ready to turn his Jewish relatives into political props, should have brushed up on his Bible. Magic and charlatans fail, and plagues turn on their deniers

    Samuel G. Freedman | Haaretz

    BACK IN LATE JANUARY AND EARLY FEBRUARY, as Jews in America and around the world read the weekly Torah portions that recounted the plagues inflicted on Pharaoh for refusing to liberate the enslaved Hebrews, the caseload for COVID-19 in the United States stood at a mere EIGHT.

    THE FIRST ILL PERSON HAD BEEN DIAGNOSED LESS THAN TWO WEEKS EARLIER.

    ON THE EVENING OF APRIL 8, AMERICAN JEWS GATHERED FOR THE FIRST SEDER OF PESACH AND AGAIN RECOUNTED THE PLAGUES.

    By the time these seders wearily concluded with the promise of “Next year in Jerusalem,” the number of domestic COVID-19 cases had risen to more than 392,000. Some 85 Americans died on Passover eve, bringing the nation’s total to 1,286.

    IN RETROSPECT, WE ALL KNOW THAT THE INCREASE DURING PESACH BARELY HINTED AT THE GLOBAL DISASTER TO COME.

    The nation of American exceptionalism is exceptional now for its failure to control a pandemic in any manner resembling most of Western Europe, or even Vietnam and Rwanda.

    BY NOW, THE WORLD HEALTH ORGANIZATION REPORTS 208,433 DEATHS AND NEARLY 7.4 MILLION CASES WORLDWIDE.

    TO FIND THE ANSWER TO THE QUESTION, WHY? We should go back to that time of Biblical plagues and autocratic rule, to see what befalls a nation headed by a leader incapable of compassion or analysis:

    THE PHARAOH WHO “HARDENS HIS HEART”.

    In the face of Moses’ entreaties to free the Jews, Pharaoh entrenches his obstinacy, serially “hardening his heart,” with God hardening it as the severity of the plagues mount.

    PHARAOH BELIEVES IN HIS COURT MAGICIANS’ TRICKERY RATHER THAN THE DEMONSTRATED POWER OF MOSES’ GOD. Believing that he can inflict drawn-out suffering on the enslaved Hebrews, Pharaoh accomplishes the opposite:

    THE FINAL PLAGUE KILLS THE FIRSTBORN IN EVERY EGYPTIAN HOUSEHOLD, INCLUDING HIS OWN. — NOW TO DONALD TRUMP:

    TRUMP WAS BLITHE ABOUT THE VIRUS WHEN, EARLY IN THE OUTBREAK, IT WAS DISPROPORTIONATELY STRIKING HIS POLITICAL FOES – the deep blue states of New York, Washington, and California; Black and Latinx people around the country; immigrants from Africa and Central America toiling in infected meat-packing plants.

    THE PRESIDENT SEEMED TO VIEW THE DISEASE AS IF IT OPERATED LIKE A POLITICAL CAMPAIGN, A BIOLOGICAL VERSION OF AN ATTACK AD, AIMED SPECIFICALLY AT HIS FOES.

    SO WHY INTERRUPT? His own voters, of course, would be safe. They didn’t need the “feminizing” wimpiness of wearing a mask.

    During the week linking the two Pharaoh-plague readings from Exodus, Trump declared in a speech:

    “WE THINK WE HAVE IT VERY WELL UNDER CONTROL. WE HAVE VERY LITTLE PROBLEM IN THIS COUNTRY AT THIS MOMENT … WE THINK IT’S GOING TO HAVE A VERY GOOD ENDING FOR US …. THAT I CAN ASSURE YOU.”

    MOST CONTEMPTIBLE OF ALL, AS WE NOW KNOW FROM BOB WOODWARD’S BOOK “RAGE”, TRUMP WAS ALREADY FULLY AWARE OF THE SEVERITY; THE AIRBORNE TRANSMISSION CAPABILITY OF COVID-19, AND THE LIFE-SAVING INFORMATION HE HID FROM THE NATION.

    ON APRIL 7, THE DAY BEFORE THE FIRST NIGHT OF PESACH, the president passingly admitted to the burgeoning caseload, and then went on to boast:

    “BUT SIGNS ARE THAT OUR STRATEGY IS TOTALLY WORKING. EVERY AMERICAN HAS A ROLE TO PLAY IN WINNING THIS WAR. AND WE’RE GOING TO BE WINNING IT. WE’RE GOING TO BE WINNING IT POWERFULLY.”

    IN BETWEEN THOSE TWO ABSURDLY SUNNY PRESENTATIONS, TRUMP BROUGHT OUT THE COURT MAGICIAN.

    In the shande fur di goyim department, the charlatan in question was a Hasidic doctor from the coronavirus epicenter of Kiryas Joel with a self-made reputation as a miracle healer thanks to the unproved drug combos he prescribed, which included the malaria drug hydroxychloroquine that Trump called a “game-changer”. REPUTABLE STUDIES ACTUALLY SAID THE OPPOSITE:

    That the medication might endanger certain types of COVID-19 patients.

    UNDETERRED, TRUMP METAPHORICALLY DONNED A CLOAK AND TURBAN – Johnny Carson doing a “Carnac the Magnificent” – TO PLAY THE MAGICIAN HIMSELF.

    On April 23, with the U.S. tally at 826,936 cases and 42,103 deaths, TRUMP ANNOUNCED THE MIRACLE CURE OF INGESTING BLEACH OR LYSOL.

    In a July interview with Fox News’ Chris Wallace, Trump offered another augury: “COVID-19 IS GOING TO DISAPPEAR AND I’LL BE RIGHT.”

    PHARAOH DON, ALWAYS SO READY TO TURN HIS JEWISH RELATIVES INTO POLITICAL PROPS, SHOULD HAVE BRUSHED UP ON HIS EXODUS. MAGIC FAILS AND PLAGUES TURN ON THEIR DENIERS.

    The top 17 states per capita COVID cases all voted for Trump in 2016, and most have REPUBLICAN governors who parroted the president’s disparagement of settled science; nine of the ten states with the fastest-growing caseload, led by Florida, went REPUBLICAN four years ago.

    WHEN TRUMP HEEDLESSLY, HUBRISTICALLY, HELD INDOOR RALLIES, LASTLY IN TULSA ON JUNE 20, COVID CASES SPIKED SOON AFTER.

    Herman Cain, the pizza entrepreneur, former presidential candidate and Trump confidante, who attended that Tulsa rally unmasked, died the following month.

    And now the plague has struck Trump, his wife, his press secretary, his campaign manager, his party’s chairperson, his hate-whisperer Stephen Miller, and such political toadies as Chris Christie, to cite just an abbreviated list. Undeterred, President Trump reframed a lethal pandemic as a divine “blessing”.

    Jewish thinkers have wrestled over the centuries with how to interpret the Biblical text’s reiteration that after Pharaoh hardened his own heart, God then hardened Pharaoh’s heart. But commentators – from Maimonides a millennium ago, to Nehama Leibowitz in more recent decades – have emphasized free will rather than divine orchestration as the source of Pharaoh’s malice and its nihilistic culmination.

    WHICH BRINGS US BACK TO THE PHARAOH OF 2020 AMERICA. Trump let a disease bring misery and death onto those he despises in blue America, whether due to active hostility or what legal language refers to as “depraved indifference”.

    BUT HUBRIS AND CRUELTY ARE NOT CONTAINABLE: Trump also delivered ruin onto his own obedient worshippers in his beloved red states, and ultimately to his inner circle and his own household.

    The story of Pharaoh’s hardened heart didn’t end with the death of the first-born Egyptians, nor with his begrudging acquiescence to the freedom of the Jews. IT ONLY ENDED AFTER HE LED HIS ARMY IN PURSUIT AND ALL WERE VANQUISHED.

    With a president so eager to see providential signs and wonders in his mishandling of the pandemic; then, using the Bible as a guide, the fate for Trump and his cult followers is to march, maskless, all the way into the swirling waters of an electoral Red Sea on November 3.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s