The Professionals’ Dilemma

What’s interesting with human society is that it is never a frozen entity; in fact it progresses and flourishes only if it is allowed to mutate. However this very quality imposes on us individuals some penumbra zones where we do not know how and what to choose in the best interest of the majority of us.

About two weeks ago some of us professionals were horrified to learn that one attorney-at-law, Mr Pazany Thandrayen, was brought straight from the airport to the police headquarters and the private files relating to one of his clients were seized for scrutiny. There was surprise that the law professionals did not make a vehement protest against this anti-democratic police procedure. That was equivalent to seizing the medical file of a seriously ill patient from his treating doctor, because of his criminal record, and that few doctors protested. No doubt there must be laws to regulate the proper functioning of society for the sake of all individuals. Similarly, it is an accepted and established rule that the relationship of professionals with their clients is sacrosanct. Subsequently the judge was therefore right to force the police to return back intact all material seized from the said attorney-at-law. A reasonable layman in our ‘Etat de droit’ could have predicted that that would be the outcome.

Doctor’s loyalty

Anyone who has read ‘Cette nuit la liberté’, depicting the history of India’s independence would remember how there was a certain Dr Patel who was the personal physician to Ali Jinnah, the father of Pakistan. He was a Hindu and knew that Jinnah was suffering from advanced tuberculosis, but he kept this confidential, and the authors of the book, Larry Collins and Dominique Lapierre, wondered whether if he had revealed this to the then Congress’ leaders, the latter might have waited for a year or two before seeking independence and thereby change the course of history.

Anyone versed with forensic medicine might have read a highly interesting book by Dr Modi. Here we were told how a doctor going around in a hotel complex saw one of his patients suffering from venereal disease having a swim in the hotel pool in Mumbai. He would have advised the patient to refrain from swimming, who had clearly ignored the caution. The doctor reported the matter to the authorities concerned, who acted promptly to vacate that patient, who sued the physician for violating his secrecy. In court, the judge disagreed and upheld the doctor’s decision, because the latter was acting for the common good of the public.

We could contrast this episode with what happened to one of our colleagues decades ago. He had administered blood to a ‘Témoins de Jéhovah’ on the operation table, because he wanted to save the life of that patient; but before operation the latter had insisted that under no circumstances blood should be transfused to him. The doctor thought otherwise – he was upholding his Hippocratic oath of saving a life. Afterwards, the patient sued that anaesthetist who was taken to task by the magistrate; he was told that he had to abide to the patient’s wish and beliefs! By refusing blood transfusion, the patient had made a personal individual choice, that’s his concept of freedom. But only a court of law can decide otherwise for the welfare, life and death of the individual — and not the doctor!

We are aware that the Americans are getting more humane in executing their policy of capital punishment. From hanging they had passed on to the electric chair and recently they switched to inject a triple ‘therapy’ to condemned prisoners and put them to death. For some time all went well, but soon a dilemma cropped up. Doctors who were participating in that program on the sly belatedly got a prick of conscience. Even their colleagues in professional circles looked down upon them as pariah and shunned them. So they withdrew from such practice, in spite of the good pay.

But that was not the end of the story: society demanded death penalty, but who would carry it out? Prison authorities trained some of its staff for the dirty job. Suddenly the pharmaceutical companies marketing the short-acting barbiturate ‘pentothal’ (to put people to sleep) woke up. Its good name would suffer from being associated with death, and its sale would plummet. So pentothal manufacture was stopped. American prison authorities had to import the drug, and the new suppliers also got wiser and refused to manufacture pentothal. There was a shortage of that anaesthetic drug, which was even felt in Mauritius. The Americans are managing to their best of possibility, but recently a prisoner took two agonizing hours to expire after injection! What new contraption will the Americans invent? Doctors and drug companies were doing quite legal activities, condoned by society and the law but as individuals, they were on the horns of a dilemma.

Of pilots

One can still remember that tragic plane crash in western Russia some years ago, as the professional Polish military pilot did his best to negotiate his plane in the midst of horrible climatic conditions. It appears that he was advised against such a landing by ground control, but he had on board the Polish president who wanted at all costs to land so as to attend a certain memorial celebration of the Second World War massacre at Katyn. The pilot thought that he should obey ground control, but his head of state thought otherwise and the poor pilot, disregarded common teaching and logic, landed and crashed, killing everyone on board. It was the price to pay for obeying to a non-professional political master, and not going according to basic rules: trying to save a maximum of lives.

That brings us to the tragedy in southern France involving the Germanwings plane. Now news is emerging that the co-pilot, Andreas Lubitz, the suicidal murderer, had several medical problems. In fact, on the day of the catastrophe he should have been away on sick leave, but he tore his doctor’s written recommendation. It seemed that his ex-girl friend, an airhostess, was pregnant. He had promised her that one day he would change the system he was working in and he would have his name engraved in bold letters. But he was suffering from a ‘bipolar’ nervous problem. We can only wonder why all this was not reported to his superiors.

Was he being treated by a private doctor and not by the company’s? Surely the airline had a duty to treat their pilot, lest some vital medical facts escaped their notice –as it did in this case. But how could an airline be aware of who among its staff members was sick or not? Was it not the duty of the treating doctor to report the adverse facts to competent authorities? Could he claim to be tied down by his duty to professional secrets? This would be a costly and painful privilege. But the law says otherwise: the doctor-patient relationship is sacred and secret.

Would the airline companies or the government come forward with rules and laws forcing doctors to supply confidential reports about pilots to their airway companies? Maybe that would be the centre of heated German debates for weeks to come. Would this be extrapolated to other instances where a few professionals are responsible for the lives of hundreds of other people at a time, as on board of a ship or a spacecraft?

The legislators

Administrators, policy makers and legislators will have a long thought – they will discover to their horror that they themselves travel by air often. Would they trust their pilots if any ailments discovered are concealed from concerned administrators by doctors? They might make a parallel with the issue of freedom of expression, of thought and belief, guaranteed by the constitution. But when we come to the health problems of the individual, it is a different story, and aging legislators would have another long thought. They would realize that almost 100% of them would be ill one day or other; would they like to have the doctors reveal their secrets – even for the sake of the good of the majority? Would they agree that their physicians come forward and cast a doubt about their advancing age, deteriorating mental and cognitive capacity and their inability to govern? Not every one of them could be 85 and still be lucid. Or would they like to maintain the doctor-patient secret relationship and benefit, much to their relief, from the windfall of that rule?

The conflicting interest of the individual and society will not end soon. What may sometimes be good for society may not be good for the individual – and vice versa. These days our financial professionals may confirm that axiom.

 

* Published in print edition on 11 April  2015

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