- - Thursday, September 18, 2014

ANALYSIS/OPINION:

I’m not a football fan, but everybody is having to watch a brilliant star being taken down and buried in a pile-up — his career jeopardized, his reputation in ruins.

There is no blood, no body and no glove. There is also no Dream Team and no jury.

There is just a medical record, a doctor’s interrogation of a child and a few welts.

Did O.J. Simpson get away with murder? A jury found reasonable doubt of his guilt. There was no doubt about the occurrence of a brutal crime.

In Adrian Peterson’s case, though, the existence of doubt is not an issue. To many, it seems that he was acting like a responsible father, disciplining a child by a long-accepted method. I remember that when I was in junior high school, boys got sent to the dean for “swats.” There were likely some welts or bruises. (Nobody checked.) The worst misbehavior was talking out of turn or chewing gum.

Did Mr. Peterson commit a crime? There is no law against corporal punishment. Did he go a little overboard? Maybe, but where are the clear legal criteria?

Doctors are required to be alert to the slightest sign of abuse and to put the worst construction on everything. All parents are viewed with suspicion, especially fathers. If you take your child to a doctor, and he has a bruise, you might be arrested, and your child might be put in foster care. The doctor is required by law to report suspected abuse, and the authorities are supposed to sort it out. The parents might be bankrupted by the legal bills.

Mr. Peterson’s son has had his privacy destroyed for life through leakage of his medical records. Once confidentiality is breached, there’s no undoing the damage. His father is no longer a hero, but a pariah.

Patients are supposed to be able to trust their doctors. Didn’t they take the Oath of Hippocrates, promising to do no harm? The Oath also states: “All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and never reveal.” The physician would have to exercise some discretion about the meaning of what ought not be disclosed — say, whether there is a public-health or criminal threat.

However, unless your doctor is elderly, he likely took “a modern Hippocratic Oath,” such as the one by Louis Lasagna of Columbia University, which is radically different from the original Oath of Hippocrates. There’s no more promise to do no harm; the doctor may even kill a patient, if he does it “with great humbleness.” Mr. Lasagna’s oath is a little vague on confidentiality: “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.” It adds an obligation to society as a whole, not just to the doctor’s patients.

The post-1980 American Medical Association Code of Ethics makes the higher duty to the state plainer: “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.” Also: “A physician shall respect the rights of patients and shall safeguard patient confidences within the constraints of the law.”

The state increasingly wants to know all. Should the physician fail to report, he can lose his livelihood. If a physician should have the opinion that a colleague declined to report something, then he has an obligation to rat out his colleague.

So far, we have apparently not made a dent in terrible abuse, but plenty of harm has been done to patient-physician and parent-child relationships, as well as to parents whose lives may be unjustly ruined.

What should physicians do? The safest course, and the one desired by the state and its public-relations firm, the press, is the one taken by the most famous prosecutor in history. He washed his hands and turned the accused over to the frenzied mob, though he himself could find no crime.

Doctors are being schooled in the need to be good soldiers: to follow orders, to ferret out any behavior disapproved by the government, and to close their eyes to the harm that may befall their patients.

Jane M. Orient, a physician, practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons.


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