Sunday 20 May 2007

Sally Clark - Medical profession hubris or humiliated


The Many Tragedies of Sally Clark is a blog I wrote about two months ago - a doctor camped out there for a few days with some comments to which I wrote a few lengthy responses, this new blog developed as a result of comments left therein.

The boss, the priest and the doctor

There was a time when people did not question their bosses, their priest or their doctor. Nowadays, the bosses can find themselves in hot water, besides, the moment people learnt how to build a career, and they took control of the decision of who they would want as boss.

The priest who still stands as succourer is now challenged in that role by the therapist with a bottle of pills and the moment people learnt to read the Bible, the word of the priest was no more as infallible as it once was, much as a good few are getting into trouble lately.

One profession that has failed to grasp the changing times and seasons is the medical profession, they still scribble in illegible handwriting and we rarely get a second opinion of their views, even in a life threatening situation.

Doing a good job

A number of cases have highlighted that fact that doctors want to be applauded as people who save life and that should be all-encompassing beyond any need for accountability or ethical adaptation to the realities of what society now expects or these professionals.

In the past week, I have been engaged within the comment fields of a certain blog I wrote a few months ago with a doctor who takes a completely different view from the tone and context of my write-up.

It was about the case of Sally Clark, the woman who was convicted and then acquitted of the murder/cot-deaths of her two infant sons, she died recently, which triggered my original write-up.

Exercise cautionary expertise

However, a good deal of my commentary centred around the mystique of expertise that exuded from the expert witness a renowned and celebrated consultant paediatrician who had formulated a behavioural syndrome which became the pivot on which the case against the many women who endured the tragedies of cot-deaths faced criminal trials.

When the famous and respected professor veered out his realm of expertise into the superfluous statistics, the judge, jury and press were completely enthralled by the numbers; it is almost beyond debate that those numbers influenced the outcomes of those cases.

When the numbers were really tested against realities, most of the convictions became unsafe, additional information about the health conditions of the victim infants seemed to point to other exculpatory evidence which was not offered as part of case evidence.

The need for moral responsibility

I stand by the views I expressed in my earlier post, professionals have responsibilities, to know what they are talking about and appreciate the value or import of their opinions on humanity, it is pertinent to be confident however one should exercise competence with a sense of consideration; it is called understanding your moral responsibility.

As the exchanges developed certain key issues arose, some like soundbites with an emotive tinge, but serious in any case, four of those issues I address below:

Doctors don't take the Hippocratic Oath - This shows how behind the times I must have been, doctors used to take this oath with the view that they pledge to preserve life. My view is the preservation no more just a physiological or anatomical issue, there other areas of social responsibility that the doctor occupies, the gravitas of their profession confers on them some sweeping purvey over their patient's lives, that issue must become part of any 21st Century medical curriculum.

Dead babies who have no advocate - I would that any baby that dies in any suspicious circumstances has a thorough, confident, intelligent, meticulous and fair advocate to state their case. The babies' and the parents' rights should and must be protected and safeguarded from unwarranted opprobrium.

The automatic imputation of guilt and liability on the parents in order to seek some sort of retributive justice for the innocents is an extreme that should be unacceptable in our society. Experts must ensure they have complete review of all the circumstances before they postulate. Where it can be proven that the parents are culpable, then that evidence and the presentation must be beyond reasonable doubt.

Doctors treat patients not laboratory results - I fear for this statement, indeed doctors should be treating patients but in most cases no treatment can conclusively be administered without the benefit of laboratory results. One good example was the subject of the 2005 Nobel Prize for Medicine, the discovery of bacteria in the stomach against the overarching body of medical knowledge. The bacterium - helicobacter pylori - was found to be causative of certain ulcers and even cancer, who would have thought certain cancers could be treated with antibiotics.

Certain evidence suggested that a cot-death victim might have died of staphylococcal septicaemia; the commentator contends the child did not die of this infection, but if the pathologist had offered this evidence to doctors when the child took ill weeks before, there might have been a different outcome from better observation.

The medical profession is against the GMC - This is where doctors need a review of their activities beyond their education and expertise; their interaction with the public.

I quote liberally from the Economist, professions have at least four elements; an accepted body of knowledge, a system for certifying mastery of that knowledge before it can be practised, a commitment to the public good and an enforceable code of ethics.

The medical profession does quite well with the first two, the commitment to the public good cannot however be monitored and validated by just the medical profession, the General Medical Council (GMC) serves the purpose of ensuring that a doctor who treats the public can cultivate the trust of the public.

Where this ability to maintain and cultivate trust is compromised, the license to practise comes under review and it can be revoked.

Saving the medical profession

Whilst there was an uproar in the medical fraternity when Professor Sir Roy Meadow was struck off, the public good was served and is what esteemed profession failed to recognise.

The GMC continues to save the medical profession from a mounting crisis of public confidence which is critical to the practise of medicine.

The commentator laments the dearth of paediatric expertise since the incident at Alder Hey Children's hospital where consultants removed for storage organs of dead children without the consent of the parents.

For the advancement of child medicine there is probably a case for removing the organs but definitely not without consent.

The bane of intellectual arrogance

Sometimes, hubris and seeming unassailability can becloud the ability for professions to recognise their moral responsibilities in a public setting and the public is getting fed up with intellectual arrogance being displayed and acted out in dictats from on high.

We might not have the knowledge or expertise but we all have access to information and these compete for attention in order to make personal quality decisions in our lives.

This is the challenge that faces the medical profession and it is one they would have to embrace from the student to the emeritus professor if they are to suffer lesser vexatious scrutiny and keep out of court or present themselves to a GMC hearing.

On closer inspection the loss of two children to cot-death was a great tragedy regardless of the class demographic; the case that followed was a travesty considering what further information made the sentences handed out unsafe; the ensuing court battles revealed a fundamental debacle and error of judgement in accepting ideas outside the professional purvey of an expert on the whole, neither medicine nor the public good was properly served.

The death of Sally Clark was the sorry end to the clash between a proud and almost arrogant profession and the public they serve.

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