Tuesday, April 21, 2009

Medical Students, Murder, and Ethics Education

On Tuesday night April 14 Julia Brisman, who offered erotic massage services on Craigslist, was murdered at the Back Bay Marriott Hotel in Boston. Yesterday the Boston Police arrested Phillip Markoff, a second year Boston University medical student, and charged him with the killing and a an earlier attack carried out in similar circumstances.

The Boston Globe article about Markoff's arrest includes a photograph showing a clean cut, handsome young man smiling as he puts on his white coat for the first time. According to a fellow student who studied anatomy with him "he seemed like a nice guy, and he was a helpful, smart kid." His former stepfather said "He's a great kid...I just can't believe what's going on...He's a very bright, intelligent, articulate guy. I just keep thinking there must be some mistake."

And of course there may be a mistake. Markoff is accused, not convicted. But the story invites speculation as to how someone who comes across as a fine person could commit murder.

My thoughts about this come from another murder. On October 31, 1999, May Greineder, wife of Dr. Dirk Greineder, a colleague I respected and admired, was murdered. I immediately wrote a letter of condolence to Dirk. I didn't know him outside of work, but I had seen a number of his patients (he was a distinguished allergist) over the years. Their description of his skill, commitment and kindness made me proud to have him as a colleague. When one of my children needed to see an allergist I had him see Dirk. Dirk knew of my interest in ethics and had contributed thoughtful observations to a project I had done. If I had been asked to name colleagues who exemplified superb medical ethics, Dirk would have been high on my list.

You can see where this story is going. On June 29, 2001 Dirk was convicted of first degree murder. He has always insisted that he did not commit the crime, and his adult children support him, but he is in prison for life. (If you want to read about this painful story, see here.)

The idea that exemplary ethics and extreme evil can exist in the same person isn't new. Robert Louis Stevenson's "Strange Case of Dr. Jekyll and Mr. Hyde" was a big seller when it was published in 1886. The Jekyll/Hyde phenomenon, and more mundane situations like the fact that Bernard Madoff, whose Ponzi scheme cost investors fifty billion dollars, was a respected philanthropist and an observant Jew, lead to soul searching about the relevance of ethics and religion to human behavior.

I teach medical ethics and consult to organizations about ethics and strategy. These are personal issues for me. Here's what Moses Pava, also a teacher of ethics, had to say about Madoff:
I got to know Bernie Madoff through his service to Yeshiva University’s Sy Syms School of Business. Until news of the scandal broke, he served as chairman of our board. I, and other faculty members, worked closely with him on an academic committee, meeting frequently at his now-infamous Midtown office.

He is charming, soft-spoken and fatherly. Like the old E.F. Hutton commercials, when Bernie spoke, people listened. As he presumably did for many others, he provided us with charismatic leadership and a strong sense of security and optimism. There was little doubt when Bernie Madoff was in the room about who was the decision-maker.

Now, of course, the money is gone, the charisma has evaporated and, instead of security and optimism, there is fear, uncertainty and concern about the future.

Personally, I begin to wonder, does my work teaching business ethics even matter? Can an academic course on business ethics really stop a would-be Bernie Madoff? Not likely.

Bernie Madoff stole gigantic sums of money, but perhaps more importantly he has diminished society’s stock of social capital. In a single stroke, the revelation of his actions has made it more difficult for us to trust one another. He has loosened the taken-for-granted connections that bind us together and robbed us of some of our faith and hope in the future. If yesterday, some of us were na├»ve idealists, today we are all hard-headed realists. And that is a shame.

But, of course, we all know that Bernie Madoff was not acting alone. He had many enablers. There are those who invested other people’s money with him and did not engage in the due diligence their position of responsibility required. There were likely others who invested with him suspecting that all was not kosher but assuming that he was earning real profits with inside information or by front-running.

Perhaps the biggest enabler though is the prevailing ethos of the business world. We live in a world that has become increasingly oriented toward a bottom-line mentality. Ours is a culture of money first. In every business school I know of, we teach our students to maximize profits. Good enough is never enough...

I will continue to teach business ethics but I have learned through recent events that this is only a tiny part of a much larger job. Unless we all become informal ethics teachers, none of us will get where we want to go.
Teaching ethics won't prevent the Madoff's of the world from carrying out crimes they fully understand to be evil. But I agree with Professor Pava that ethics education has a role in improving individual behavior and organizational conduct. I'll say more about this role in future postings.


Anonymous said...


Having just started to work part-time in a prison, the examples of Markoff and Madoff (how similar their names!) surprise me even less. People who are narcissistic, bright, and sociopathic are quite capable of fooling most of us. Lots of interesting ethical challeges in prison psychiatry. All should experience at least once! Maybe a little less trust, especially about investing, is called for.
I also wrote about Madoff in terms of "investing" in a mental health clinician. Here, too, it may be buyer beware, at least to some degree (see "Investing in a Psychiatrist", www.clinicalpsychiatrynews.com, P.17, March 2009).
Steve Moffic

Jim Sabin said...

Hi Steve -

How good to hear from you!

Your comment about prison work and talented sociopaths are very relevant. We can all learn some humility as well as caution from stories like the ones you must encounter in that work.

Thanks for the reference to your article in Clinical Psychiatry News. Like your other writings on psychiatry and ethics it is excellent. (Readers - you can get free access to Clinical Psychiatry News via the website.) Your discussion of how people can find a therapist they can trust is illuminating.



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