[Posted on behalf of Nancy Dubler and Art Caplan]
Surprising that for a week there was constant news from Boston. Minute by minute we heard details of carnage, searching, killing, lock down and capture. Now, pretty much, silence.
The suspect, captured in a boat in a backyard in Watertown, is now both a prisoner and a patient. That has proved, historically and most recently, to be a difficult dual status for physicians to address. It is hard for those who want to interrogate him. And hard for those who wish to initiate his arraignment and prosecution. But they along with the rest of us must wait.
Prison and jail health care present an anomaly for medical caregivers. The goals of medicine are to diagnose, cure and comfort. The goals of the justice and correctional systems are to confine, try, sentence and punish. These are not only mutually exclusive goals but, they make strange and strained bedfellows when the two must work together.
We know one can coopt the other. American doctors who agreed that torture could continue, without killing the prisoner, during recent years when water-boarding was a clear part of the anti-terror arsenal, violated their oaths as physicians to attend only to the medical, physical and emotional needs of the patient…to do no harm.
In the same vein, on July 17, 2008, the AMA articulated its policy about executions clearly and unambiguously — “requiring physicians to participate in executions violates their oath to protect lives and erodes public confidence in the medical profession. A physician is a member of a profession dedicated to preserving life when there is hope of doing so. The use of a physician’s clinical skill and judgment for purposes other than promoting an individual’s health and welfare undermines a basic ethical foundation of medicine — first, do no harm”. Yet physicians do participate in executions often using their respect for the criminal justice system as their rationale.