Law And Order And Ethics

Law And Order And Ethics


Leonard Zwelling

The attached article from The New York Times website of February 28 describes a truly horrifying course of events. Apparently, at least three fertility doctors in the Rochester, New York area used their own sperm to impregnate their patients, when different anonymous donors were supposed to have been used. As shocking as this is, it was the basis of a widely-viewed Law and Order episode called “Seed” from 1995. This current fertility fraud was discovered by one of the off-spring through DNA testing when he found his biological father was not who he thought he was and in fact he had over 10 half siblings all of whose mothers had the same fertility doctor.

If you want to know why the public does not trust doctors and why I was always so skeptical as a vice president overseeing clinical research of what I was being told, this is it.

Somewhere in the minds of these doctors, they thought it would be all right to create their own basketball teams, clans of clones, or armies. This is something out of Ira Levin and The Boys From Brazil. But it goes right to the heart of what it means when a doctor with the gift of healing abuses that gift instead for nefarious purposes when that the doctor himself (and it’s always a he) puts his own beliefs above medical ethics.

This is also the reason that we have human subjects protection rules in the Code of Federal Regulations and why organizations like the FDA are so necessary. People are not inherently good. Doctors are people. Doctors do not inherently follow the Hippocratic Oath of “above all, do no harm.” Doctors have state licensed power to do harm and must self-discipline and have watch dog groups constantly monitoring what they are doing and making clear what is ethical and what is not.

This is also what got so mixed up in the response to the Covid pandemic and the use of vaccines. We as a society were stuck between mandating the use of vaccines for public health reasons and allowing individuals to decide whether or not they would be vaccinated as exercises in their right to free choice about what to do with their bodies. It would seem obvious that everyone should want to be vaccinated against Covid. But that is not the case. It was the case in 1954 when the Salk vaccine for polio was introduced to the public. But that was before the FDA got to decide safety and efficacy (both were necessary of new drugs and devices after 1962). The horrors of the Tuskegee abuses were not public yet and the trust between the American public and its government was far higher than it is today. Now, as the Law and Order episode predicted in 1995, medical ethics can be fluid as exercised by licensed practitioners. Now, today, we have a real- life case of several doctors abusing the trust of their vulnerable patients and adult children having to withstand these revelations.

It is likely these doctors will go unpunished. They’ll keep their licenses although the ones in Rochester are either old or dead. Chances are this behavior only got more prevalent after the AIDS crisis made screening sperm donors another expense of fertility clinics and using their own sperm cut the doctors’ costs and assured them that the babies born would not be infected in utero.

This is another dismal chapter in the history of medical ethics and the article suggests that this practice of using their own donated sperm was not limited to these three doctors. It’s another black eye for medicine which needs no additional ones given the level of trust between medicine and the public right now and the constantly shifting advice from putative health experts.

Politicians may have loused up our response to the Covid crisis, but we in medicine bear some of the blame as well. The more we examine the response of society to the pandemic, the worse our decisions look in retrospect (remember wiping off your groceries?).

We say we want to stick to the science. If we do then we have to say when the science is not there yet as it really isn’t clearly for the proper use of vaccines in the various age groups with and without boosters. As far as I can tell, no one knows whether a fourth shot is a good idea, but Pfizer has appealed for emergency use for a fourth shot yesterday. Let’s see the data.

We in medicine have to figure out a way to communicate honestly with the public, say when we don’t know something, and police ourselves for people who spread nonsense (ivermectin use in Covid) or act unethically. We need to clean up our act.

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