Ethics forum considers duty of physicians in public positions

Las Vegas -- In March 2005, Senate Majority Leader Bill Frist, MD, viewed an hour-long videotape of Terri Schiavo and questioned whether the Florida woman at the center of a national debate about end-of-life care was in a persistent vegetative state.

"She certainly seems to respond to visual stimuli," the Tennessee Republican and cardiovascular surgeon said on the Senate floor. Was Dr. Frist wrong to make such a statement?

When Kentucky Gov. Ernie Fletcher, MD, signed a death warrant for a convicted murderer, did he violate ethical policies that say physicians should not participate in executions? What duties do physicians have to uphold medical ethics when serving in nonphysician roles?

These were the questions put to physicians who attended the Council on Ethical and Judicial Affairs open forum at the November Interim Meeting.

"There are some things that pertain strictly to the job description, such as signing a death warrant as governor," said Michael A. Williams, MD, an American Academy of Neurology delegate. "But Sen. Frist basically misused his roles and responsibilities as a physician as a way of making a political statement. He made a diagnosis without examining the patient and without the requisite expertise."

Patrick W. McCormick, MD, an alternate delegate from Toledo, Ohio, said that when a physician's medical background gives special consideration or privilege in a public role, the ethical duties still hold.

"There are two instances where our [Code of Medical Ethics] should apply to those engaged outside of care of patients," Dr. McCormick said. "If an MD is necessary to hold their position, for example as the medical director of an insurance entity, or if the MD training is used to warrant special credibility to give medical opinions, which I think would cover Sen. Frist."

Other delegates questioned whether such a situation is an issue of medical ethics or personal judgment and asked CEJA to draw the line.

Delegates also were asked to weigh in on the ethics of sedating terminally ill patients who no longer respond to palliative care. Several delegates who spoke said they had used sedation as a palliative measure at a patient's or surrogate's request, but that the practice was rare and carefully controlled.

Most physicians who spoke agreed that the practice was ethical when warranted. They asked CEJA to clarify, however, whether sedation also should be used to alleviate existential, or psychiatric, symptoms when patients are near death.

The open forum issues that CEJA chooses to pursue could be studied for as long as 18 months.