Who Is Fit to Practice Medicine?

April 12, 2010 • Posted in Medicine & Health

First published 13 April 2009; reprinted here by the kind permission of www.bioethics.com (http://bioethics.com/author/jriley/)

Recently, I learned that Sweden is struggling with an important question: who should be trained as a physician? One particular student focuses this discussion. Karl Helge Hampus Svensson was banished a year ago from Sweden’s premier Karolinska Institute on the grounds that he had falsified high school records. Lying is not a noble activity for anyone, especially would-be physicians. Correction was necessary. Mr. Svensson was relieved of his medical student status. It was probably not the lying that caught the attention of the school officials, however. Mr. Svensson, a Nazi sympathizer, was also a murderer, who had served the time required in Sweden for such a crime. So what is Sweden’s difficulty now? It has come to light that Mr. Svensson is, once again, a medical student – this time at Uppsala, another Swedish institution of higher learning. (Lawrence K. Altman, M.D., “A Quandary in Sweden: Criminals in Med School”) How did this happen? Apparently an assumed name helped provide the cover for a while. How should this school respond? If a citizen has been convicted of murder, should that person, after “repaying the societal debt”, be entrusted with the lives of others? In a country where background checks by medical schools are not allowed, what is to be done? So far, only questions; answers are not yet forthcoming.

The United States is dealing with questions regarding medical practice as well – but not about medical students and crime. The question in the U.S. is about which physicians will be allowed the freedom to practice according to their consciences. Since the combination of Roe v. Wade andDoe v. Bolton made abortion a “right” during any stage of development of the embryo (up to eight weeks after conception) or fetus (eight weeks after conception until birth) in the United States, physicians who objected on moral grounds were not required to participate in such procedures. “Right of conscience” of health care workers was recognized and respected, although no regulations existed to provide for that right of conscience. Shortly before President Bush left office, after a period of public comment, regulations regarding right of conscience of health care workers were published in the Federal Register. The Obama administration has signaled its probable withdrawal of conscience regulations, and gave the American people until 9 April to comment on that. If healthcare workers lose the right of conscience, they will lose a precious freedom. Only physicians who are willing to perform or refer for abortions may be allowed to practice obstetrics. Some recommendations have been made which state that if physicians who are not willing to perform abortions do not practice in close proximity to those who do (perform abortions), the former need to relocate. Patients in rural areas may pay the highest price in this equation. If obstetricians must practice in proximity to abortionists, and no abortionist is near, the only care the rural patients have may need to relocate?! Truth is truly stranger than fiction.

The questions the U.S. and Sweden are each asking meld together as I think about them. They came into stark focus when I watched a video that someone I do not know called to my attention. It is a video called Everyone Against Abortion, Please Raise Your Hand! It begins sweetly and deteriorates from there. This video has seared my mind. Sweden mulls the prospect of entrusting vulnerable patients to a convicted murderer. The United States is considering having only abortionists (or persons who will refer to abortionists) practice obstetrics. Is this not two sides of the same coin? Both countries are asking, “Who is fit to practice medicine?” If I am a patient in an examination gown awaiting the physician’s arrival, am I comfortable in either Sweden or the U.S. at this point?