Ducking The Issue

OVER IN BOSTON at Brighan and Women's Hospital and the Harvard Medical School, a small group of doctors and administrators are quietly perfecting the art of ducking an issue. Two months ago, public fury exploded after the revelation that two BWH doctors, both Med School affiliates, had written glowing professional recommendations for Dr. Arif Hussain, failing to mention his rape conviction handed down only a few weeks earlier. Administrators at both institutions expressed "regret" about the unfortunate incident, but they refused to comment further on the case. Instead of confronting the difficult issues raised, they deferred judgement on both the physicians' actions and the more complicated ethical questions involved to two joint committees formed within the staff of the organizations.

Now the first of these committees has reported in, and its response is far from satisfactory. "It is our conclusion," the BWH-Med School fact-finding committee writes, "that members of the anaesthesia staff received inappropriate legal advice and acted inappropriately in following that advice. Clearly, the result was unfortunate for the individuals and institutions involved, and for the public trust."

The legal advice received by the physicians who recommended Hussain is certainly relevant to the case, raising as it does questions about the propriety of the hospital's counsel. However, this advice is not, as the fact-finding committee seems to suggest the central issue. Even if BWH attorneys instructed the doctors to omit the rape conviction reference, they were obligated to include it--or to refuse to write the letters at all. Whether or not the doctors acted legally, they did not act ethically and it is this ethical question that the administrators of both institutions must address.

Contending that its internal self-discipline is sufficient to prevent abuse, the medical community has traditionally demanded a degree of autonomy greater than that granted to many professions. But in order to retain that public trust, physicians must be willing to confront difficult ethical questions when they arise. We hope the second joint committee, instructed to draw up guidelines for writing recommendations, will remind physicians that, particularly in medicine, moral questions cannot be separated from professional ones. By recommending a firm set of guidelines, we hope the second committee will succeed where the first has failed.