Saturday, January 26, 2008

Murder and Medical School

I've never had an ethics consultation like the one that could have come from Karolinska Institute in Stockholm: "We just found out that one of our medical students has done time for murder -- what should we do?"

This extraordinary story was in yesterday's New York Times. In 2000, Karl Svensson, now 31, was convicted of killing Bjorn Soderberg. Soderberg had complained to his employers about neo-Nazi materials a co-worker had displayed. The co-worker, a friend of Svensson's, was fired. Svensson himself had been under surveillance for his own neo-Nazi activities.

Svensson was sentenced to 11 years in prison, but was paroled after 6 1/2 years, as is common in Sweden. While in prison he took many web-based courses and did well enough to meet the Karolinska entry requirements. In a remarkable failure of interviewing, neither of the admissions officers he spoke with asked him about the 6 1/2 year gap on his CV!

When the story came to light, Svensson's fellow students were split. Many felt he had done his time and should be allowed to become a doctor. Others reported being afraid of having him as a classmate.

The students who wanted Svensson to stay had a point. Respect for every person is a core medical value. Physicians care for murders as well as their victims. Physicians believe that change, and repentance, are possible.

People convicted of murder can be outstanding physicians. In 2001 a medical specialist to whom I had referred many patients, including a member of my own family, was sent to prison for the 1999 murder of his wife. (He maintains his innocence.) He did more than provide excellent technical care - he gave outstanding human attention as well. I was moved by my patients' description of his skill and compassion and was proud to have him as a colleague.

But the Hippocratic Oath articulates another value - "In purity and holiness I will guard my life and my art."

The classmates who wanted Svensson to stay in Karolinska were half right. People who have done their time should have the opportunity to build a new life. For all we know Svensson may have had wanted to make amends for the crime he had been convicted of. But for me the Hippocratic value is the deciding point here. Medicine has its anthropological roots in religion. Many of the prophets in all religions were healers of the body as well as the soul. The obligations the privilege of being a physician entails go beyond what we do in the office and hospital.

I hope that Svensson is committed to making up in the rest of his life for the murder the court concluded he had done. But Karolinska Institute, which expelled him last week, did the right thing.

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