Ethics-Easier Said than Done

Although I consider myself a good general physician, as well as being very good in my chosen specialty, I am neither a psychiatrist nor a pediatrician. Since this blog deals a lot with issues concerning autism, I don't usually put on my "doctor" hat here. But sometimes some subjects get to me not just as the parent of my autistic son, but also as a physician.

The recent episode of the NYU Child Study Center's (together with its director, Dr. Harold Koplewicz) "Ransom Notes" campaign raises serious ethical concerns that I think need to be addressed. Kristina Chew over at Autism Vox summarized many of the excellent responses by the autism community to these ill conceived ads. I'm going to address this purely from the perspective of a fellow physician.

I have always considered the ability to practice medicine a privilege that is granted me by society. Having been granted that privilege, I, like all physicians, have certain responsibilities towards not only my own patients, but also to society in general.

The American Medical Association, as one of the major professional associations of physicians in the US, publishes Principles of Medical Ethics which all physicians are expected to adhere to. I'd like to take a few minutes here to review some of what is stated in that document. Here's one section that I found:

E-9.123 Disrespect and Derogatory Conduct in the Patient-Physician Relationship



The relationship between patients and physicians is based on trust and should serve to promote patients’ well-being while respecting their dignity and rights. Trust can be established and maintained only when there is mutual respect.

Derogatory language or actions on the part of physicians can cause psychological harm to those they target. Also, such language or actions can cause reluctance in members of targeted groups to seek or to trust medical care and thus create an environment that strains relationships among patients, physicians, and the health care team. Therefore, any such conduct is profoundly antithetical to the Principles of Medical Ethics. ...

On its website NYU's Child Study Center (CSC) gives good lip service to subscribing to the above principle:

Our key goals include:

* Increasing the body of scientific knowledge about child mental illness
* Eliminating the stigma of being or having a child with a psychiatric disorder
* Improving the practices of professionals serving children
* Influencing child-related public policy

How does that square with the "Ransom Notes" campaign, where they have ads such stating things like:

We have your son.

We will make sure he will
not be able to care for
himself or interact socially
as long as he lives.

*This is only the beginning.

Autism

Now I might expect something like the above ad twenty years ago, or perhaps now from someone who is totally ignorant regarding current concepts in autism. But from a major medical center's Department of Child Psychiatry? Never. Such rhetoric is blatantly wrong, totally derogatory, and sure to increase discrimination against all autistics. To hide behind a justification of "increasing awareness" is disingenuous at best, and outright lying at worst.

The "Ransom Notes" campaign is all about publicity. Whether it's viewed as primarily advertising for NYU's CSC (which I do), or as a public service message, the following section of the AMA's Principles of Medical Ethics addresses this point.

E-5.02 Advertising and Publicity


...Aggressive, high-pressure advertising and publicity should be avoided if they create unjustified medical expectations or are accompanied by deceptive claims. The key issue, however, is whether advertising or publicity, regardless of format or content, is true and not materially misleading. ...

Again, the gross factual inaccuracy of the description of autism renders this ad unethical.

When it comes to Psychiatry, the World Psychiatric Association also has some things to say regarding ethics. This comes from them commenting on psychiatrists and the media:

• Psychiatrists addressing the media. The media has a key role in shaping the attitudes of the community. In all contacts with the media psychiatrists shall ensure that people with mental illness are presented in a manner which preserves their dignity and pride, and which reduces stigma and discrimination against them. An important role of psychiatrists is to advocate for those people who suffer from mental disorders. ...

Keep the above in mind while reading this:

We have your daughter.

We are making her wash her hands until
they are raw, every day.

This is only the beginning.

-OCD
----------------------------

We have taken your son.

We have imprisoned him in
a maze of darkness
with no hope of ever
getting out. Do nothing
and see what happens.

-Depression

Preserving dignity and pride? Reducing stigma and discrimination? Not in my book.

Now from Googling Harold Koplewicz and reading about him, before this I wouldn't have thought him a bad guy. He's written several books, including one titled "It's Nobody's Fault:New Hope and Help for Difficult Children and Their Parents". He's a Vice Dean, Full Professor, and Department Chairman at a prestigious university, and has received numerous awards from various groups, and has appeared often on mainstream media. He's not some fly by night practitioner of woo that I would expect such claptrap from.

But now I'm going to address the good doctor directly.

Harold, I may be a simple country doctor in flyover country, but I gotta tell ya. Your reputation alone isn't going to get you thru this one. It's time to "man up", take the hit, and admit that you got this whole campaign totally wrong. Everyone can make a mistake, and you made a big one. Being "edgy" doesn't cut it when the ads going out in your name are full of untruths and are frankly unethical in their demeaning portrayal of those with a variety of conditions. Accept responsibility, apologize sincerely, and go on. Do so, and people will listen and be willing to start a dialogue with you. Keep delaying, and this will only get bigger. You've succeeded in uniting and galvanizing widely disparate groups of people against this campaign, and secondarily against you.

Be the physician your record would indicate you have been. Do the right thing.