by William Kay, M.D.
The phrase "medical ethics" sounds great in principle, but some important questions remain unanswered. Who is deciding what is ethical in medicine? How are those decisions being used? In this article we will explore some of the very ugly uses of modern "medical ethics", namely the protection of hospital assets, limiting patient choices, obliterating the physician-patient relationship, and allowing hospital administrators to bully medical staff.
Medical ethics committees were originally created in the 1970's and promoted as a means to protect patients from being abused by an evolving medical system that was becoming increasingly driven by greed. Today's hospital-based ethics committees are almost universally comprised of members who have been personally chosen by the C.E.O. of the hospital, who are themselves businessmen with no medical education. The C.E.O.'s primary job at a hospital is to increase profits. It is starting to look like the fox has been placed in charge of protecting the hen house, isn't it?
Hospitals have special nurses called "utilization nurses" (that do not have any patient care responsibilities) who make rounds every day and read every doctor's order, on every patient, inside every major hospital in the United States. Their sole job is to identify ways to save hospital money. Now, imagine a utilization nurse decides that the treatment plan that your doctor ordered will not make the hospital as much money as she believes it should. After notifying your doctor that it is her recommendation to choose a more profitable form of treatment, your doctor protests, "I am the doctor, and the treatment chosen is the best one for the patient". The doctor is very likely to face a reprimand from the C.E.O.-appointed ethics committee for violating the supposed ethic of being uncooperative with staff and purportedly placing the community at risk for not supporting the local hospital. You can imagine the threat to the career of a physician who is professionally labeled as "unethical". Let me paint the grim picture: loss of hospital privileges, dropped from insurance panels, potential loss of license, and ultimately the end of his career.
The above scenario is not simply hypothetical. This is an active system that changes millions of doctor orders a day across this country — all for the sole purpose of increasing hospital profits, and enforced by the power of modern medical ethics. In my own experience, while practicing as a surgeon, I was called about twice per day on my patient orders. In fact, my orders were often changed by the utilization nurse if she couldn't contact me immediately! It had been illegal in the U.S. to change a doctor's orders if you were a nurse, but with the power of the ethics committees, nurses are directly supported by the C.E.O. as "ethically" acting in the best interest of the community!
In future articles about "medical ethics" I will share my experiences and knowledge concerning hospitals that use these committees to violate patient wishes, family wishes, taking custody of children, approving organ donation in trauma victims that were still alive and not registered as organ donors, forcing burn victims to submit to excruciating treatments against their wishes, and the list goes on.