Tuesday, October 14, 2008

The truth of the matter

This update of a case came to my attention while perusing the recent journals in dealing with organ transplantation. It is commentary on the journalistic reporting the case of California vs. Roozrokh. It is found in The Hastings Center Report At Law section "Jesting Pilate"-of July-August 2008, p14-15 (www.thehastingscenter.org) by Carl E. Schneider (He is the Chauncey Stillman Professor of Law Professor and Professor of Internal Medicine at the University of Michigan as well as a member of the President's Council on Bioethics) - This case involves a new transplant surgeon who was accused in the New York Times of murder: "Surgeon Accused of Speeding a Death to Get Organs." (http://www.nytimes.co/2008/02/27transplant?_r=1&oref=slogin). The case is one dealing with Donation after Cardiac death (DCD) and has significant warnings and possible chilling implications. The author's point however has to do with what is presented to the public and what is true. In his own investigation of the case he found that there had been a preliminary hearing, a ruling, and a judicial opinion. The surgeon had not been charged with murder but with three felonies, only one of which will be permitted to go to trial: "dependent Adult Abuse...by willfully causing the patient to be placed in a situation in which his health was endangered by the prescription of excessive amounts of morphine and Ativan, and/or by introduction of Betadine into the stomach."(1). This count is much less serious than that of homicide and the prosecutor would only have to show that the surgeon was criminally negligent.

The patient had adrenoleukodystrophy, which damages the nervous and muscular systems. This is a genetic condition. He had been admitted in a coma and his mother gave consent to withdraw life support and made him an organ donor. He was not brain dead. The transplant surgeon in question was not involved in any of these decisions. But the surgeon had apparently never before been involved with DCD cases, nor had any of the hospital staff, nor had the transplant coordinator, the chief of transplant surgery at the institution had never been involved with one, and there was no written of national DCD policy. There was much confusion in the evidence gathering regarding the frequency and dosing of narcotics. There was a preliminary hearing and not a trial where facts are found in discovery and put in evidence.

The author's point is that journalistic reporting of the law is often poor and inaccurate, few journalists have legal training. The law itself is fragmented and difficult to cover. Finally the point is made that most legal events take a long time to sort out. The questions this poses are many as are the lessons- is this murder or a series of mistakes and inexperienced personnel? Is the rush to journalistic judgment appropriate or is it sensationalism to sell newsprint? For ethicists this brings up such issues as ethical oversight of reporting practices, criticism of the editors who do nt insist on fact checking, another instance of self policing that does not work. The bigger question of which is DCD appropriate at all and, if so, where is the national policy that should be followed? It would seem that Donation after Cardiac Death entails lively and active bioethical input.

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