Saturday, July 26, 2014

The death penalty, the ABA and political extortion of physicians by the Boards

Three major journals have now published about the extortion of american physicians-the political force of certification revocation-and ONLY the ABA (anesthesiology)  of all boards has done this. Please consider the following and anyone needing a copy of any article contact me off line. The first is particularly salient-the second displays the ABA's firm and clear position that certification loss threatens ability to practice and should be used to extort physician complliance to board's whims-decided by 20 pompus individuals who do not practice medicine, but politics:
Societal and Medical Ethics: Regarding Execution by Lethal Injection
Multiple recent opinions regarding physician execution and corporate American board prohibitions raise many important issues. (1-3) As physicians and definitive experts, we are obliged by society to participate in many aspects of dying: terminal care, ICU admissions or denials (fiscal and physical triage), euthanasia, withdrawal of life support, abortions, heart beating and non-heart-beating organ donation and “do not resuscitate” classifications and indications. Such involvement as anesthesiologists has recently been deemed “imperative” (4) In modern industrial societies, over 90% of ICU deaths are “managed events”. (5) Organ donation euthanasia is being discussed as a means to facilitate the supply of needed organs, as have been invasive non-heart-beating methods. (6) Optimally, organs are recovered from heart-beating donors: perhaps it is time to discuss or provide medical care to recover all useful organs from the
condemned, who choose to donate organs before circulatory arrest, as an act of contrition, to benefit living patients and increase their hope of living. Brain dead donors are as legally “declared dead”, as are those condemned to die and are without hope of further life. Death is certain at this point. Ronald Phillips, a condemned murderer, has recently been denied the opportunity to donate organs and benefit others, which would have been readily possible, humane and practical, using standard heart beating donor methods. ( 7, 8) Why refuse and to what purpose?
Times have changed since the American Medical Association (AMA) issued it’s opinion
guideline first issued in 1980 and last revised in 2000, stating, "A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. The AMA now represents less than 20% of physicians and by no means, the profession as a whole. Medical ethics must reflect contemporary society, which even the AMA openly declares. The US population danced in the streets after Osama Bin Laden was “terminated”. Drone attacks are now contemporary federal policy-even directed at US citizens. Organ recovery has been a priority for over a decade in the US. The Ohio Medical Board recently specifically prohibited involvement in “the actual administration of the execution agent itself”, while only two death-penalty states, Illinois and Kentucky, specifically bar doctors from the execution chamber. No one should be forced to participate in an execution, be restricted from following their conscience, voicing their opinion
or performing legally sanctioned actions including “consulting with ……. lethal injection personnel”.
The only board, the American Board of Anesthesiology (ABA) and original signer issuing the prohibition noted: “Even though board certification is not required to practice medicine, in many fields it is a de facto requirement for physicians to practice within their specialties.” (2) The ABA has thus threatened to revoke certification for capital punishment involvement of any kind, including consulting distant from the actual act. Dictating as a dozen corporate enforcers without legal mandate, assuming to represent the profession and threatening an individual’s employment ability without a voice of the diplomates, who are not members but merely rent the diplomate under current artificially created corporate recertification licensing, is a mere political ploy, remaining itself unethical and frankly un-American. The prohibition of involvement in lethal injection occurred with significant dissent from the national American Society of Anesthesiologists. * It is noteworthy that the Boards have used this same threat and
regulatory capture to force physicians to subscribe to their corporate programs, profiting only the boards (netting $400 million annually), while devoid of outcome based data demonstrating any quality improvement from their certification or recertification programs, in spite of repeated attempts over decades. (9) This was summarized in the ABIM’s own internally sponsored Meta-analysis. (10) These corporate and political actions raise serious questions as to the ethical nature of these boards themselves, operating without effective external oversight by the profession itself. “Business ethics” should not supersede professional ethics, who do not serve or represent the professionor society at large.*

Personal Communication, Alexander A. Hannenberg, MD

1) Waisel DB: Revocation of Board Certification for Legally Permitted Activities. Mayo Clin Proc. 2014;89:869- 872.
2) Truog RD, Cohen IG, Rockoff MA. Physicians, medical ethics, and execution by lethal injection. JAMA. 2014 Jun 18;311(23):2375-2376.
3) Sawicki NN: Clinicians' involvement in capital punishment--constitutional implications. N Engl J Med. 2014;371:103-105.
4) Papadimos TJ, Gafford EF, Stawicki SP, Murray MJ. Diagnosing dying.
Anesth Analg. 2014 Apr;118(4):879-82
5)Widdicombe NJ, Van Der Poll A, Gould A, Isbel N. Donation after cardiac death in nonsurvivable burns. Anaesth Intensive Care. 2013;41:380-385.
6)Wilkinson D and Savulescu J: Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics. Jan 2012; 26(1): 32– 48.
7) Associated Press: Death row inmate's wish raises ethical questions November 14, 2013. Available at: Accessed 7/19/2014
8) Kempen PM: Lethal Injection, Anesthesia, Medicine and Organ Donation – Ethical and Clinical Considerations Regarding the Pending Supreme Court Case: Baze vs Rees. The Open Anesthesiology Journal, 2008, 2, 7-12.
9) Kempen PM: Maintenance of Certification and Licensure: Regulatory Capture of
Medicine. Anesth Analg. 2014 Jun;118(6):1378-86.
10) Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board
certification and clinical outcomes: the missing link. Acad Med 2002;77:534–42 

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