The Ethics of Teaching Ethics

Abstract

Recently, some state boards of professional licensure have begun to turn to ethicists for assistance in evaluating the behavior of professionals against whom complaints of unethical conduct have been brought. In the following case, a state board has made it a condition of a health professional's reinstatement that he take a course in medical ethics. Although much disguised here to preserve the anonymity of all parties, this case is based on an actual series of events. Dr. Emil Gessup was a plastic surgeon who became well known in the Williamstown area during the last two decades for his successful major reconstructive work with the victims of several well-publicized accidents. He also had a solid reputation among internists in the area, especially for his skill in removing, almost without a trace, the small beginnings of basal cell carcinomas on the face and neck. Moreover, after insurance companies began covering outpatient surgical procedures, Dr. Gessup began performing such procedures in his office whenever doing so posed no added risk for the patient. However, over the last two and a half years, several dozen unrelated complaints of professional misconduct had been filed with the state licensing board, including a number of complaints of sexual misconduct. Although no criminal charges had been filed, eight different female patients who did not know each other and who were unaware that other complaints had been filed against Dr. Gessup, had testified to the board that while they were under nitrous oxide anesthesia, Dr. Gessup had touched their sexual organs. When faced with these charges, Dr. Gessup challenged the legal jurisdiction of the state board to pursue its investigation. The court found in favor of the board and ordered Dr. Gessup to respond to the board's charges. Dr. Gessup denied any wrongdoing and testified that he had performed a thorough examination to determine whether these patients, who had all presented for the removal of suspected basal cell tumors from the face or neck, had systemic infections as might be indicated by lymph node enlargement He denied that palpating patient lymph nodes in the breast and groin areas was unethical. The board was particularly convinced by the testimonies of one patient and that of Dr. Gessup's receptionist. The patient had emerged from anesthesia early and began a struggle with Dr. Gessup, which caused the receptionist to enter the operatory. In addition to these charges, other patients had reported that Dr. Gessup had falsified insurance reimbursement claims. The board found that in violation of his professional license Dr. Gessup had wrongfully palpated the genitalia of the complainants, and had misrepresented treatments performed in reimbursement claims filed with several insurance companies. Under state law, the board could issue a formal reprimand, or temporarily suspend Dr. Gessup's license and set reasonable requirements for reinstatement, or permanently revoke the license. The board voted to suspend his license and stipulated the following conditions for reinstatement: Completion of a refresher course in diagnosis and treatment of basal cell carcinomas of the face and neck; completion of one year of unpaid supervised practice for which he must compensate the supervising physician; and passing a course in professional ethics at the state's medical school. Two months prior to completing his one year of supervised practice, and after completing the diagnosis course, Dr. Gessup contacted the Dean of the school in which you teach a required medical ethics course. Dr. Gessup communicated the board's findings, and requirements, and requested permission to enroll in the course so that he might regain his license as soon as he has completed his supervised practice. The course is conducted in large lectures followed by small discussion groups, and is required of all fourth-year medical students. One case is discussed in each of the four 1 1/2 hour discussion sessions. …