Ermingarden (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
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agonyaunt2021-12-14 05:36 pm
ermingarden) wrote in agonyaunt2021-12-14 05:36 pm
Entry tags:
The Ethicist: Colleague Prescribing Ivermectin
A very close, decades-long friend who has been a professional colleague — we are both family-practice doctors, though we currently work in different states — is spreading misinformation when it comes to Covid-19. She thinks vaccines have toxic ingredients and are unnecessary. She also thinks that the case and death rates of Covid are overblown. Recently, she emailed that she has been prescribing ivermectin and hydroxychloroquine for use against Covid.
As bad as I think her misinformation is, I feel that she has crossed the line in prescribing drugs that multiple studies have shown are not effective for the prevention or treatment of Covid-19. Professional standards state that I must report her to the state board of medicine, just as I must report a colleague who was abusing drugs or alcohol. On the advice of a former medical-school classmate who is a bioethicist, I wrote to my friend stating that she could lose her board certification and her state medical license.
As might be expected, she is not vaccinated and has no plans for her or her family to be vaccinated. Obviously, I will not change her mind. As bad as I think her advice is for herself and her family, though, it is wrong and harmful when it comes to patients in her care. So what do I do? –Name Withheld
There are over a million active physicians in the United States — more than the entire population of Austin, Texas. Even if a vast majority respect the practice guidelines set by their medical boards, there will be those whose training proves no match for the misinformation that incubates online, and their absolute numbers will not be insignificant. Sometimes ideological identities can undercut professional ones. When doctors reasonably believe that a member of their profession is endangering patients, they should pass what they know on to the medical authorities in the states where they work. Alas, you have good grounds for such concern. That she’s your friend made it appropriate to tell her first that you thought she was exposing herself to risk for violating the strictures of her profession. At this point, though, your obligations as a medical professional are the overriding ones. The sort of misinformation she’s both purveying and putting into practice is among the reasons that this pandemic’s costs in sickness and death have been so great.
As bad as I think her misinformation is, I feel that she has crossed the line in prescribing drugs that multiple studies have shown are not effective for the prevention or treatment of Covid-19. Professional standards state that I must report her to the state board of medicine, just as I must report a colleague who was abusing drugs or alcohol. On the advice of a former medical-school classmate who is a bioethicist, I wrote to my friend stating that she could lose her board certification and her state medical license.
As might be expected, she is not vaccinated and has no plans for her or her family to be vaccinated. Obviously, I will not change her mind. As bad as I think her advice is for herself and her family, though, it is wrong and harmful when it comes to patients in her care. So what do I do? –Name Withheld
There are over a million active physicians in the United States — more than the entire population of Austin, Texas. Even if a vast majority respect the practice guidelines set by their medical boards, there will be those whose training proves no match for the misinformation that incubates online, and their absolute numbers will not be insignificant. Sometimes ideological identities can undercut professional ones. When doctors reasonably believe that a member of their profession is endangering patients, they should pass what they know on to the medical authorities in the states where they work. Alas, you have good grounds for such concern. That she’s your friend made it appropriate to tell her first that you thought she was exposing herself to risk for violating the strictures of her profession. At this point, though, your obligations as a medical professional are the overriding ones. The sort of misinformation she’s both purveying and putting into practice is among the reasons that this pandemic’s costs in sickness and death have been so great.
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There's no question here. LW is ethically bound to report her to the board of medicine and to tell her employer (if she has one) that she isn't vaxxed, and to do it today.
People like the friend have no business working in healthcare. she's an active danger to her patients.
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As I read it – and this is reading a good deal into LW's words, so I could be wrong – the question boils down to: "At what point are the negative consequences to my personal life of fulfilling a particular ethical obligation in my professional life severe enough that I would be justified in not fulfilling that ethical obligation?" And it's fascinating to me that Appiah doesn't actually explicitly acknowledge the personal cost to the LW. There's a brief consideration of the appropriateness of giving the friend notice before reporting, out of special obligations to a friend, but nothing about the loss of the friendship.
Obviously, there are points at which personal cost does actually outweigh professional ethics. (As an extreme example, suppose it's a choice between refraining from reporting the friend to the board of medicine and literally dying; I doubt most people would blame LW for not reporting in that scenario.) But by not explicitly acknowledging that the loss of the friendship could even be a factor in that sort of balancing of interests and obligations, Appiah seems (to me) to imply that wherever the line is beyond which personal cost can outweigh professional ethics, LW's situation doesn't come remotely close.
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If I had a chance to talk to LW I might say something like "I'm sorry your friend has killed your friendship by rejecting the science you were both educated in and by treating her patients unethically, but she is the one who has killed it with these actions. If you don't report her you're just letting the friendship's corpse stumble around for awhile, possibly to be joined by the corpses of her patients -- can you ever really trust her again after she's done this?"