by Admin
Michael Jackson and Medical Paternalism
“She soft peddles the frequency with which doctors shield themselves from liability at the expense of patients, but its a start.”
Siobhan Reynolds PRN Jul 28, 2009
Michael Jackson and Medical Paternalism
By Charlotte Laws,
Jul 28, 2009
“Michael Jackson’s doctors have been described as greedy, selfish enablers with ‘blood on their hands,’ but isn’t it just as likely they are caring individuals who are willing to risk personal liability to help the suffering?”
Since Michael Jackson’s death, there has been a push to use the long arm of the law to ransack the pharmacy shelves and pluck out a killer. Law enforcement and the public seem thirsty for the arrest of one or more of Jackson’s doctors on charges of homicide, or more specifically manslaughter. A physician can be legally responsible if he is found negligent or reckless in the death of a patient.
Dr. Conrad Murray was present during Jackson’s last moments, and if he physically administered a lethal drug, it would, of course, place him directly in the firing line. But what about the dozens of physicians who have written prescriptions for the singer over the years and who are now being tracked down and investigated? The indirect act of prescribing medications can expose an MD under the law, but should it? Should the law be changed to shift a greater degree of responsibility to the patient?
Medical paternalism is interference in a person’s health by a doctor, the FDA or another “authority” because the “authority” is assumed to know what is best for that person. It is imposed against a patient’s will, results in a limitation of autonomy and can spiral into a “you can’t handle the truth” philosophy in which pertinent information is withheld from the sick.
Michael Jackson used aliases and “doctor shopped,” which means he went from one physician to another until he acquired the medications he desired or needed; and a tremendous amount of evidence suggests he required drugs to function. Debilitating insomnia had plagued him for years, just as it did Elvis Presley and Heath Ledger, both of whom also died from prescription drug overdoses.
Michael Jackson’s nurse, Cherilyn Lee, says the singer begged for a powerful sedative, even though he knew it could be dangerous, because he was desperate to sleep; and publicist Rob Goldstein says Jackson would dance for eight hours straight in his hotel room hoping it would make him tired. Two months prior to his death, Heath Ledger revealed his agony in getting only two hours of sleep per night; and Elvis Presley’s doctor, George Nichopoulos–whose medical license was suspended when the singer died—says Presley got no more than three hours of sleep at a time. Presley was caught in demanding cycle of needing energy at showtime, then seeking sleep so he could feel refreshed the next day. Perhaps medication was the only solution if he wanted to remain an international star rather than an infirm recluse. Jackson had just left a more secluded life to jump into a grueling rehearsal and concert schedule when he overdosed.
It is all too easy for those who are free from pain and from crippling insomnia to mount their moral high horse and preach about willpower and alternative remedies. Most insomniacs have tried everything, still suffer and turn to heavier and heavier medications. Check the Internet blogs and sleep disorder forums; talk of suicide is as routine as brushing ones teeth.
“I’ve had insomnia for 14 years,” one person writes. “What is the value in a life with chronic unrelenting insomnia night after night?” Someone replies, “I am at 13 years, contemplating suicide.”
A lawyer comments, “If I get off meds, I can’t do my job,” and a teacher says, “I’m literally fighting to stay awake as soon as the day begins. I feel like death. I am only 25, and I look like I am 35-40.”
An unemployed woman writes, “My $200 per hour doctor is no help. He won’t prescribe sleeping pills because he is worried I will deliberately overdose. But life is not worth living. All I do is cry.”
Is this how Michael Jackson, Heath Ledger and Elvis Presley felt? If so, one can understand their desire to try hardcore medications, even at the risk of addiction, injury or death. Plus, life in show biz is demanding: a person must be at his best regularly and at exact times, a Herculean feat for someone with chronic insomnia.
Michael Jackson’s doctors have been described as greedy, selfish enablers with “blood on their hands,” but isn’t it just as likely they are caring individuals who are willing to risk personal liability to help the suffering? Dr. William Hurwitz has been described as such a person. He was a Virginia pain management physician, but now sits in jail for prescribing drugs that some of his patients abused. His property was seized by authorities, and after his practice closed, two patients reportedly killed themselves because of untreated pain.
Mentalist Uri Geller and one of Michael Jackson’s bodyguards claim they confiscated anesthesia injection equipment from the singer and screamed at him to quit taking drugs, but he ignored their warnings. Jackson was clearly willing to assume the risk, so why can’t his fans and family respect this decision? He would certainly want to be held personally responsible for his health-related choices rather than witness what could be described as a modern-day witch hunt against physicians who were arguably just trying to help.
Personal responsibility is unfortunately out-of-style. Today’s society is like a game of dodge ball: there is a tendency to skirt responsibility, shoving a scapegoat out in front to be struck and blaming the team’s loss on him. History teaches us that sins are symbolically washed away when a scapegoat is punished; it’s a ritual that seems to provide psychological satisfaction for a mourning nation that needs an answer to failure and loss. I believe this explains why doctors are routinely and overzealously pursued when a celebrity dies of a prescription overdose and why there is public outrage towards the doctors in Michael Jackson’s life.
Perhaps my libertarian tan lines are showing, but I think doctors, the FDA and other “authorities” should be advisors rather than powerful patriarchs who can shove their mighty pen in their pocket, depriving patients of medications which may be their only hope for a pain-free life. Centralized prescription databases—which are being launched throughout the nation–are risky, “big brother” enterprises that should be discontinued until such time as patients are given greater control over their own health.
In general, people assume a passive role in their medical lives, mindlessly trusting doctors. Instead they should be legally entitled to take greater responsibility for their own wellbeing and encouraged to research the pros and cons of their medications, in addition to pondering—rather than robotically accepting–the advice offered by health professionals. It is simple to log onto Internet forums and read about drug side effects and benefits, as well as clinical studies.
To assure patients are properly advised of side effects, signed disclosures could be required along with impartially produced Internet videos outlining the disadvantages and advantages of a particular drug. The goal would be threefold: proper disclosure, input from a doctor and tools that help individuals make decisions that are right for them.
Regulating medicine through criminal law enforcement is misguided and counterproductive, and could lead to fewer physicians, especially in the chronic pain management field. According to the Association of American Medical Colleges, there is already likely to be a shortage of 124,400 doctors by 2025. There are medical professionals today who specialize in “self-defense,” by putting their own desire to stay out of criminal court above the interest of the patient. Some flat-out refuse to treat those with chronic pain due to the ever-present oppression and intimidation by law enforcement. The Hippocratic Oath should not be at war with the Drug Enforcement Administration.
Individualism and self-determination are fundamental values that most of us cherish; however, in medicine, they rest on the pharmacy’s dusty back shelf. Medical paternalism is outdated and not a panacea.
America needs a new prescription; and frankly, I think Michael Jackson would agree.”
http://www.thesimon.com/magazine/articles/bias/01636_michael_jackson_medical_paternalism.html
That is a problem that most of us old-timers – and at 54 I am indeed an old-time in this group of relatively short-lived patients – tend to have the same problem. In the seemingly never-ending round of inadequate and/or incorrect treatment to to zero treatment to almost correct treatment to abuse and back and forth and around again, eventually one learns which medications actually worked or did some good, which caused problems, which caused so many or such bad side-effects that the little help was not worth it, which were most helpful and which were useless. Even when, as with me, almost every doctor I’ve seen has at least accepted that I must really be in pain because having that much damage without having pain is inconceivable, some still refuse to admit that I might know anything about my own care. Twenty-five years is generally enough time in the field, education and diligent study and hands on experience to qualify anyone as an expert in a given field, but not in the field of chronic intractable pain. Instead, the old Inquisitor’s “reasoning” tricks of lying language and twisted logic are used to justify doctor’s refusals to take my word or sound and proven medical science for anything, and to take away any input into my own care but refusal, which could lose me any treatment at all, leaving me a curled-up ball of agony, unable to move, often to eat, or to rest.
The halfway state I’m in now should constitute medical abuse, yet it doesn’t to most people, and the accusation that I tend to try to “dictate” my own treatment treatment, simply by existing as an unsupported accusation denies all other tests that say I’m supposedly in the top .02 percent of the population in intelligence. That one adaptable regimen that was worked out by two doctors and me over years of effort had me looking for job retraining or help with a business loan while I was working part-time and taking care of a house, a garden, 12 pets and actually living a life for once. Instead of recognizing that, when circumstances dictated activities and levels of activity that I suddenly had no control over (my wife was bedridden and dying and I had no help) it was bound to increase the pain, a new doctor I was tricked into seeing and lied to about and by unilaterally threw out the entire regimen as “useless” against my wishes and despite evidence that should have been undeniable. This so-called healer knowingly crippled me at a time and in a way that could, and may have, caused my wife’s early death through neglect, and that plus his refusal to recognize my home or transportation or financial situations at all very nearly drove my wife and me to suicide. Even my drop in weight from 200lbs to 143 lbs made no particular impression on this man, and my desire for the medication that worked best in the most effective doses were treated as lack of cooperation, an attempt to dictate my own treatment and “Drug Seeking Behavior,” on my part, any of which supposedly justifies complete medical abandonment in the VA system. My quarter century of diligent study, my survival against increasing odds, my scrupulous and proactive honesty for the past two decades and more of working out and using the one good regimen my doctors and I ever found and my long, direct experience with “treatments” that do not help, make me ill or that cause or are likely to case effects that I cannot or will no longer tolerate all means nothing again. They were and remain willing to endanger my life and/or see me homeless again rather than admit they are wrong and adhere to the medical standard of care, their own oaths, medical ethics that should apply to all doctors everywhere, and to the law.
I phrase it as I did because my wife perished last month in my arms, probably sooner than she would have if I had been as functional as I had been before the actions of one smug, dishonest and vicious medical Luddite and a deadly system willing to defend an unjustifiable medical attack on a patient nearly killed us both more than once. I was lucky enough to find a modicum of help that was and is still inadequate outside the VA system, at the cost of money that was badly needed for other things and of sacrificing much of what remained of my own health to care for my beloved and best friend at the end of her life as well as I could. Her death was bound to be a difficult one due to the nature of the disease that was killing her, but we were both forced to do without the medications we should have had because of this dangerous physician and a system that will not hold him to account, nor is the system itself or the doctors who operate within it accountable. I must now deal with the consequences of this time alone and somehow try to put a life and a home I may yet lose back together, starting over yet again.
I am more damaged now than I have ever been, in more ways than I like to think about. Over the years I have lost almost everything that I could not carry with me to unavoidable debts, to thieves and careless storage and to many other things I could not control. I can now add to those losses a lifetime in what should and could have been my best working years in a strong and healthy youth, and worse even that that, the sweet, strong and sharply intelligent, generous and extraordinary woman who saved my life, a gift I was unable to return this time. She fought for me when I no longer could, and when she would not fight for herself. I was privileged to be able to up take up that burden for a little while, and we were both surprised to find ourselves in a love we had each concluded didn’t really exist. Well, I was surprised. I loved her more than I love my own life, and now that I see it in front of me in print I realize that I always will. Her loss dims the world she moved in in ways I have yet to define or measure; it’s a poorer, sadder place than it was. Now, alone again, I have to start over yet again. How many times that is I have no idea anymore beyond knowing it’s “too many.”
America’s medical system, like it’s political and economic systems now, is undemocratic, un-compassionate and uncaring, greedy and grasping, dehumanizing, often vicious, ignorant, bigoted and needlessly destructive destructive of the life and the lives it was putatively created to protect and to serve. Sadly, those last five words that once served honestly as the motto of police departments everywhere in the U.S. now belong in that sentence and the list of faults it enumerates more than it does on the doors of police cars and stationery.
The law and those who are entrusted with the extraordinary power and the terrible responsibility to enforce it now serve corporate masters and their Great and Holy Bottom Line whether they choose to recognize that truth or not. Twisting the law to suit their own desires for ever more power and profits, corruption that was once met with the loathing and quick action of decent people, and nowhere more than amongst those who work in the administration of justice, is slowly becoming the rule instead of the rarity it was. As it turns out, medicine, especially the pharmaceutical industry, has been on that road for a long time, and corruption, always contagious, rises with profits like disease in blood agar in the presence of sufficient warmth; fed on blood and heat, both corruption and disease grow. As cops and lawyers, too many of them corrupt, take over the regulation of portions of the medical field basing their standards on experience that says where there are drugs and money there must be crime and criminals, the physicians who once determined treatment standards with their own well-trained expertise, the desperate patients who must rely on them find themselves being treated as targets of opportunity caught between out-of-control thugs with badges and guns they should not have and doctors who are caught in an impossible double bind themselves. The Department of Justice, more often called the Department of inJustice lately, together with the ONDCP and the DEA on down to local police all over the country are now addicts them0selves, unable to cease grasping and abusing power that by Constitutional law they should not have no matter who or how many innocents it damages or destroys. If this is paternalism, it is that of an psychotic and abusive father who will not trust his children with the lives that belong to them, preferring to destroy those lives himself rather than allow them to live as they choose, something that should be the right of all children, and something that is indeed the right of the adult citizens of the United States. The only way they are able to do such awful damage is to keep for themselves the superior weaponry and to misuse their authority and the prisons, and then to attack the most helpless citizens they can find, the poverty-stricken sick and injured, with all the power of a militarized police and punishment-mad, power-hungry, corrupt and greedy agencies.
From a government of, by and for the People, they have become another pack of wolves loosed among the sheep and rampaging through the hen house, destroying the very enterprise, America, that they were created and have sworn to protect.
Ian MacLeod
Activist PRN. Nonprofit, Nonpartisan, 501(C)(3) Corporation.
Progressive Political Activist.
Veteran, Disabled, Chronic Intractable Pain Patient, 25 years
Primum, non nocere!
Illegitimis non carborundum!
NOTE: I added two sentences and some corrections to the above comment and sent them to:
http://www.thesimon.com/magazine/articles/bias/01636_michael_jackson_medical_paternalism.html
which is the URL of the original magazine or newspaper article.
Ian