Friday, May 04, 2018

Resistance: ethical standards matter, even if this clown forgot


It's easy to take recent episodes involving the president's long haired former doctor as comic relief amid the swirling morass of Trump scandals. Sure, the doc looks like he escaped from some back-to-the-land commune. And Dr. Harold Bornstein's purported assessment of Trump's health in 2015 -- "astonishingly excellent," “the healthiest individual ever elected to the presidency” -- never seemed that plausible. Now we learn that after the inauguration, Trump muscle men (some in U.S. government employ) raided Bornstein's office and made off with the originals of Trump's health records. Those records both belonged to the doctor and were searched out from among other confidential records. Oops. Then Bornstein passes on that he allowed Trump to write his own 2015 "health assessment." It certainly reads like everything we expect from the Tweeter-in-Chief.

But medical ethicists point out, in depth, that, in the service of Donald J.Trump, Dr. Bornstein has been breaking the rules of his profession.

If Trump did dictate the letter to Bornstein, Bornstein’s license to practice medicine should be revoked, said Jonathan D. Moreno, an ethics professor at the University of Pennsylvania’s Perelman School of Medicine.

“He has said that he lied, that he signed something under duress. Well, that’s tough,” Moreno said. “As a doctor, your obligation is to the well-being of the patient, which includes the ongoing care of the patient. And if he felt he couldn’t go along with it, he didn’t need to sign it.”

... when their patients are celebrities or people who wield enormous power, some doctors can lose their way. Several experts noted pop star Michael Jackson’s ability to get his doctor to prescribe the powerful sedative propofol.

 With “athletes, movie stars or the president, sometimes the balance gets tipped,” said Chris Winter, a neurologist at Charlottesville Neurology and Sleep Medicine in Virginia and author of “The Sleep Solution.”

Said [Robert D. Truog, director of the Harvard Center for Bioethics]: “I believe, in working with celebrities or politically powerful people, it can be very difficult to hold that line. But it’s critical that we do hold that line because the trust of the public is at stake.”

As Trump's next doctor, Admiral Ronny Jackson, found out, getting involved with Trump can leave once honorable figures hung out to dry.

Once again, I'm reminded of one of Yale historian Timothy J. Snyder's list of impediments to destruction of democratic government in On Tyranny:

Professions can create forms of ethical conversation that are impossible between a lonely individual and a distant government. If members of professions think of themselves as groups with common interests, with norms and rules that oblige them at all times, then they can gain confidence and indeed a certain kind of power. Professional ethics must guide us precisely when we are told that the situation is exceptional. Then there is no such thing as “just following orders.” If members of the professions confuse their specific ethics with the emotions of the moment, however, they can find themselves saying and doing things that they might previously have thought unimaginable.

In the Trump era, it's often been lawyers who've been called to choose between professional ethics and advantage or advancement. Diplomatic corps professionals who adhered to their own standards and therefore opposed this president's election have been blackballed from the State Department. Professional ethics can undergird resistance to a culture of lying and abuse of power in many arenas of public service.

The Australian military has passed about a demanding maxim which seems peculiarly suitable to rising above our aspiring authoritarian president's ethical swamp:

The standard you walk past, is the standard you accept

There are standards far more important than loyalty to Dear Leader.

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