Tuesday, June 7, 2011

Anthony Weiner and Medical Ethics

Representative Anthony Weiner's tearful confession of having (a) sent lewd photos to women over the internet and then (b) lied recurrently after the first photo emerged, is the news of the day. (For overseas readers and the rare U.S. reader who do not follow U.S. gossip, here's a link to a New York Times article and editorial on the story.)

Weiner's ridiculous internet photos and messages were immature. He clearly violated the House ethics rule that representatives should conduct themselves “at all times in a manner that shall reflect creditably on the House.” And his baldface lies were reprehensible. He says, however, that he will not resign.

For two reasons, I hope Weiner can tough it out.

First, U.S. political process has a deeply hypocritical double standard. When Sarah Palin and Newt Gingrich lie about "death panels" in the health reform law, they cause profound public harm, but suffer no disgrace for the damage their mendacity causes. But when Elliot Spitzer consorts with a prostitute, and Anthony Weiner struts his physique on Twitter and Facebook, we are shocked, shocked, and pillory the perpetrators.

Spitzer and Weiner have simply made fools of themselves. Palin and Gingrich have caused widespread harm. If we want to get serious about destructive public conduct, let's address the what's truly harmful!

Second, Weiner's press conference confession is a refreshing antidote to the more characteristic political stance of evading responsibility and blaming others, as in Donald Rumsfeld's lame "stuff happens" response to the fiasco of looting we allowed to go on in Iraq. Weiner spells out the embarassing behavior he carried out on internet, and clearly acknowledges his lies.

In medicine we often care for people who have done wrong. In my psychiatry residency I was startled when one of our teachers (using an old fashioned word) asked a patient who had treated others very badly - "how does it feel to be a bum?" The question led to a serious exchange. The patient had indeed acted in a reprehensible manner. The challenge he faced was whether he could make amends, learn from his experience, and become a decent human being. That's what our teacher suggested we try to help him with. The phrase "tough love" wasn't in use then, but that's what he was recommending.

AA's 12 steps apply tough love to the effort to recover from alcoholism. The AA member is asked to make "a searching and fearless moral inventory" (step 4), to make "a list of all persons we had harmed, and became willing to make amends to them all" (step 8), and then to make "direct amends to such people wherever possible, except when to do so would injure them or others" (step 9).

If Weiner follows the wisdom of these steps he could improve our political dialogue by (a) continuing to take full responsibility for his actions and (b) working to promote higher standards of responsibility-taking in our culture. If he can do this he will be helping us improve our capacity to follow Gandhi's teaching, that we should hate the sin but love the sinner.

That's a capacity that health professionals must develop. Our patients need to know that we love them even as we confront the destructive behaviors they may manifest.

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