4 ms·

The fact that people are defending this guy, or treating it as "no big deal" blows my mind. Just off the top of my head, a few ethical issues: - Breach of

by dvt 9y ago

The fact that people are defending this guy, or treating it as "no big deal" blows my mind. Just off the top of my head, a few ethical issues: - Breach of patient-doctor trust -- a very asymmetric relationship - Breach of the Hippocratic Oath (you don't *burn* healthy tissue without good reason) - Permanent bodily modification without consent - *Multiple* offenses Should he have been terminated? Does the punishment fit the crime? Considering he was a leading surgeon in his field, I honestly don't know. One would have to consider potential future lives saved compared to these ethical breaches. It's a tough call, for sure, but to exonerate him or, worse, downplay these egregious violations as "victimless crimes" is, to me, unfathomable.

andrewstuart 9y ago
This is why there's so many ethical issues coming to the forefront these days ... people grade things into "acceptable" levels of bad behaviour.
- Fnoord 9y ago
  I don't see anyone in this thread claiming this is acceptable. What some people are doing/saying is putting it in proportion: compared to things like cutting someone an arm loose (either intentionally, or unintentionally), murder, assault, and robbery this is far less bad. Because there's no permanent damage, and nothing was taken away. The initials even get removed over time. Is it bad? Oh yeah, it is, because the relationship between these 2 is professional and top down (doctor being authority on the matter, patient being sedated). I haven't seen anyone arguing this person shouldn't be punished. > people grade things into "acceptable" levels of bad behaviour. So I don't see anyone grading anything into acceptable levels of (bad) behaviour. Putting behaviour in proportion to find adequate punishment is part of the judiciary system which you can find back as working decently since trias politica invention.
simplyfantast 9y ago
I've been a physician for about 16 years. I won't defend the guy, it's just that I routinely see things that I would consider worse: doctors drunk at work, doctors who sleep with medical students in exchange for good evaluations, rampant cheating in medical school, rampant stimulant abuse, and the list goes on and on... It's unethical for sure, but I guess my gut reaction is that it's not necessarily an offense that demands termination.
- deleted 9y ago
  [deleted]
- deleted 9y ago
  [deleted]
- theprotocol 9y ago
  >it's not necessarily an offense that demands termination. Someone murdered someone near my workplace. This surgeon branding his initials on someone's liver isn't so bad in comparison. Therefore, it isn't so bad in the absolute. You set up the slope yourself and then proceeded to slip on it.
  - saiya-jin 9y ago
    Reality is, tons of doctors have all kinds of issues (my fiancee is a doctor in one of the biggest hospital in Switzerland). As mentioned - substance abuse, tremendous pressures at work and massive overtimes (suicides aren't that rare, some just quit profession or downgrade to become a nurse). Ever thought that when you are admitted, doctor will quickly check youtube to look FOR THE FIRST TIME how to perform some minor (or not) procedure? Ever thought that patients would die or get seriously, permanently injured just because somebody forgot to do some checks? You thought that most senior surgeons are just workoholic egomaniacs, dependant on various legal or illegal substances that healthy person shuldn't touch, ever? And this is Switzerland. In ideal world, you're completely right. In real world out there, where ALL OF US make mistakes all the time, including doctors, this is really 'meh' category that I wouldn't mind at all on me, as long as doctor's performance is consistently solid. Maybe slap on the wrist in form of demotion / ban of practice for a year or two. Put a mandatory psychological treatment for true reason of this behaviour (we're society after all and should help each other, not banish them to hell for any mistake). Otherwise, if your would apply super high standards consistently across all staff, you would see plenty of people dying due to no staff in hospitals. Sad but real.
- bdcravens 9y ago
  You don't think he should lose his license?
- 9y ago
gadders 9y ago
If he'd done it to me, I'd have carved my name on his forehead. Completely unacceptable. //edit// I'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership".
- jacquesm 9y ago
  I would not have retaliated in kind but most likely would have retaliated in court, and I would have pulled out all the stops to inflict maximum damage. So I'm sympathetic to your response but to react to the point where the damage you do is worse than the damage that was done to you - in spite of the breach of trust - is probably not the best course of action. Also, I've seen that movie.
  - gadders 9y ago
    I'm exaggerating, but I do think sometimes when a physical wrong is done to your person it requires a physical response.
- mcphage 9y ago
  > I'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership". That's because of the use of the word "branding", which is what cattle farmers do to their animals to indicate ownership. Had they used something more value-neutral like "initialed", our reactions wouldn't be nearly as strong. (I'm not saying that "branding" is the wrong word to use, nor that "initialed" would have been better, just that the specific words we hear matter, even when their meaning is mostly the same)
hycaria 9y ago
To me this is really no big deal. Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in this case, but there's a reason doctors are disciplinally judged by their peers in some countries. But it's really dumb, and should lead to disciplinary consequences (although his reputation is already badly damaged) because of the paranoia it triggers in people about doctors. What I wonder is why the surgeons who discovered it got the problem out in the public. What was possibly their goal ?
- theprotocol 9y ago
  >Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in this case, but there's a reason doctors are disciplinally judged by their peers in some countries. You must be Dr. Manhattan. It's a big deal to us uneducated ants but you're enlightened so you can see it for what it is, is that right? Actually, you are simply too arrogant to see it.
  - hycaria 9y ago
    It's important, just not for the reason most commonly accepted ie risk for the patient yada yada. Easy question : do you know what it looks like ? I think no picture has been published, I infer what it probably looks like out of what I've seen and my experience which is relevant in this case, but most people are probably not able to do so (this is arrogant I guess ?). BUT it is indeed bad and damaging for the doctor/patient relationship, which is today even more prevalent than the care one.
    - theprotocol 9y ago
DanBC 9y ago
A minor nit, but it's not a permanent body modification. The marking is supposed to heal. He was caught because he marked a liver and it didn't heal because that patient was ill and another surgeon found the mark. He was prosecuted and convicted for a minor offence ("assault by battery" is almost the lowest level of this offence) and because he pled guilty the more serious charge ("assault causing actual bodily harm" (ABH)) was dropped. Some doctors in UK have been convicted of manslaughter by gross negligence (a far more serious criminal charge) and were able to return to practice after a time of suspension, so he might be able to return to work. He's been through a hearing at MPTS (the independent medical tribunal service) after a complaint to the GMC (the regulatory body for doctors in UK). I think it was an interim hearing, and they're waiting for the criminal trial to finish. But here's the warning he got: > In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning. They had several options: they could have prevented him from working; they could have required him to take action to prevent re-occurance.

by dvt 9y ago

andrewstuart 9y ago

This is why there's so many ethical issues coming to the forefront these days ... people grade things into "acceptable" levels of bad behaviour.

Fnoord 9y ago
I don't see anyone in this thread claiming this is acceptable. What some people are doing/saying is putting it in proportion: compared to things like cutting someone an arm loose (either intentionally, or unintentionally), murder, assault, and robbery this is far less bad. Because there's no permanent damage, and nothing was taken away. The initials even get removed over time. Is it bad? Oh yeah, it is, because the relationship between these 2 is professional and top down (doctor being authority on the matter, patient being sedated). I haven't seen anyone arguing this person shouldn't be punished. > people grade things into "acceptable" levels of bad behaviour. So I don't see anyone grading anything into acceptable levels of (bad) behaviour. Putting behaviour in proportion to find adequate punishment is part of the judiciary system which you can find back as working decently since trias politica invention.

simplyfantast 9y ago

I've been a physician for about 16 years. I won't defend the guy, it's just that I routinely see things that I would consider worse: doctors drunk at work, doctors who sleep with medical students in exchange for good evaluations, rampant cheating in medical school, rampant stimulant abuse, and the list goes on and on... It's unethical for sure, but I guess my gut reaction is that it's not necessarily an offense that demands termination.

deleted 9y ago
[deleted]
deleted 9y ago
[deleted]
theprotocol 9y ago
>it's not necessarily an offense that demands termination. Someone murdered someone near my workplace. This surgeon branding his initials on someone's liver isn't so bad in comparison. Therefore, it isn't so bad in the absolute. You set up the slope yourself and then proceeded to slip on it.
- saiya-jin 9y ago
  Reality is, tons of doctors have all kinds of issues (my fiancee is a doctor in one of the biggest hospital in Switzerland). As mentioned - substance abuse, tremendous pressures at work and massive overtimes (suicides aren't that rare, some just quit profession or downgrade to become a nurse). Ever thought that when you are admitted, doctor will quickly check youtube to look FOR THE FIRST TIME how to perform some minor (or not) procedure? Ever thought that patients would die or get seriously, permanently injured just because somebody forgot to do some checks? You thought that most senior surgeons are just workoholic egomaniacs, dependant on various legal or illegal substances that healthy person shuldn't touch, ever? And this is Switzerland. In ideal world, you're completely right. In real world out there, where ALL OF US make mistakes all the time, including doctors, this is really 'meh' category that I wouldn't mind at all on me, as long as doctor's performance is consistently solid. Maybe slap on the wrist in form of demotion / ban of practice for a year or two. Put a mandatory psychological treatment for true reason of this behaviour (we're society after all and should help each other, not banish them to hell for any mistake). Otherwise, if your would apply super high standards consistently across all staff, you would see plenty of people dying due to no staff in hospitals. Sad but real.
bdcravens 9y ago
You don't think he should lose his license?
9y ago

gadders 9y ago

If he'd done it to me, I'd have carved my name on his forehead. Completely unacceptable. //edit// I'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership".

jacquesm 9y ago
I would not have retaliated in kind but most likely would have retaliated in court, and I would have pulled out all the stops to inflict maximum damage. So I'm sympathetic to your response but to react to the point where the damage you do is worse than the damage that was done to you - in spite of the breach of trust - is probably not the best course of action. Also, I've seen that movie.
- gadders 9y ago
  I'm exaggerating, but I do think sometimes when a physical wrong is done to your person it requires a physical response.
mcphage 9y ago
> I'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership". That's because of the use of the word "branding", which is what cattle farmers do to their animals to indicate ownership. Had they used something more value-neutral like "initialed", our reactions wouldn't be nearly as strong. (I'm not saying that "branding" is the wrong word to use, nor that "initialed" would have been better, just that the specific words we hear matter, even when their meaning is mostly the same)

hycaria 9y ago

To me this is really no big deal. Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in this case, but there's a reason doctors are disciplinally judged by their peers in some countries. But it's really dumb, and should lead to disciplinary consequences (although his reputation is already badly damaged) because of the paranoia it triggers in people about doctors. What I wonder is why the surgeons who discovered it got the problem out in the public. What was possibly their goal ?

theprotocol 9y ago
>Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in this case, but there's a reason doctors are disciplinally judged by their peers in some countries. You must be Dr. Manhattan. It's a big deal to us uneducated ants but you're enlightened so you can see it for what it is, is that right? Actually, you are simply too arrogant to see it.
- hycaria 9y ago
  It's important, just not for the reason most commonly accepted ie risk for the patient yada yada. Easy question : do you know what it looks like ? I think no picture has been published, I infer what it probably looks like out of what I've seen and my experience which is relevant in this case, but most people are probably not able to do so (this is arrogant I guess ?). BUT it is indeed bad and damaging for the doctor/patient relationship, which is today even more prevalent than the care one.
  - theprotocol 9y ago

DanBC 9y ago

A minor nit, but it's not a permanent body modification. The marking is supposed to heal. He was caught because he marked a liver and it didn't heal because that patient was ill and another surgeon found the mark. He was prosecuted and convicted for a minor offence ("assault by battery" is almost the lowest level of this offence) and because he pled guilty the more serious charge ("assault causing actual bodily harm" (ABH)) was dropped. Some doctors in UK have been convicted of manslaughter by gross negligence (a far more serious criminal charge) and were able to return to practice after a time of suspension, so he might be able to return to work. He's been through a hearing at MPTS (the independent medical tribunal service) after a complaint to the GMC (the regulatory body for doctors in UK). I think it was an interim hearing, and they're waiting for the criminal trial to finish. But here's the warning he got: > In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning. They had several options: they could have prevented him from working; they could have required him to take action to prevent re-occurance.