Dr. Emmette Flynn: Second, Do No Harm…?

 Posted on February 17,2012 in Uncategorized

Patients should be able to decide what happens to them. Doctors should not do things that harm their patients.

According to Wikipedia, the principles are autonomy, the patient's right to self-determination; and beneficence, serving the best interests of the patient.

Autonomy can come into conflict with beneficence when patients disagree with recommendations that health care professionals believe are in the patient's best interest. When the patient's interests conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. Western medicine generally defers to the wishes of a mentally competent patient to make his own decisions, even in cases where the medical team believes that he is not acting in his own best interests. However, many other societies prioritize beneficence over autonomy.

It's easy to think of cases in which autonomy and beneficence clash-the patient doesn't want the medically required treatment, or the patient wants treatment that is not medically helpful (see, e.g., Joan Rivers).

But when could it possibly be okay for a physician to perform a medically unnecessary procedure on a competent but unconsenting patient?

My understanding of medical ethics is informed by reason, by legal ethics, and by Wikipedia. So scholars of medical ethics might have a handy answer to this question other than the one that to me appears obvious, which is:

Never.

A couple of days ago I mentioned a Fifth Circuit opinion in which the court found a search unreasonable but upheld it based on the "good faith" exception to the Fourth Amendment's reasonableness requirement. The opinion keeps bugging me because of something that wasn't legally relevant: San Angelo, Texas surgeon Dr. Emmette Flynn's nonconsensual and medically unnecessary sedation and performance of a proctoscopic examination on a suspect.

As far as I can tell, there is no authoritarian "compliance with law" exception to the principles of autonomy and beneficence. There shouldn't be. Medical professionals making exceptions to both of those principles to comply with the sovereign's commands (First, do what the government says) would be well down a slippery slope that we've slid down before. So if Dr. Emmette Flynn had been ordered by a court to perform an unnecessary and risky procedure on an unconsenting competent patient, he should have refused on ethical grounds and called a lawyer to fight the order.

But the state didn't have to order Emmette Flynn to cooperate; he violated his Hippocratic Oath willingly:

The judge ordered Gray to be presented to a "qualified medical technician to examine [Gray] for the concealment of controlled substances and to remove said controlled substances from his body in accordance with recognized accepted medical procedure as described in [Hethcock's] affidavit."

Assuming for the sake of argument that Emmette Flynn is not a sociopath to whom medical ethics mean nothing, all it took for him to cast those ethics aside was a police officer asking for help.

If Emmette Flynn had said to the police, "I can't do that without the patient's consent," Rondrick Gray wouldn't have been subjected to what the Fifth Circuit described as "one of the greatest dignitary intrusions that could flow from a medical procedure." That's entirely on Flynn, the doctor sworn to do no harm.

This is a problem with American society: that Americans are too willing to unquestioningly do what the government asks. Just as Emmette Flynn could have prevented Mr. Gray's degradation by simply behaving as medical ethics require, every American could prevent any number of violations of our privacy and dignity by critically examining the demands of the government, and then following the dictates of their consciences.