Wednesday, September 8, 2010

Bloodgate - a Medical Ethics Violation that Wasn't Sexual

If you don't follow international rugby you probably haven't heard about "Bloodgate."

In April, 2009, Harlequins was trailing Leinster 6-5 in the quarter finals of the Heinecken Cup in Twickenham, England. Harlequins Winger Tom Williams suddenly spouted blood from his mouth, which allowed the team to substitute Nick Evans, a specialist kicker, for him. (It didn't work - Evans's kick missed, and Harlequins lost.) But it wasn't blood coming out of Williams's mouth - it was fake blood, from capsule the trainer had given him.

Leinster and the officials were suspicious. In the locker room Williams panicked. He entreated Dr. Wendy Chapman, an emergency room physician acting as team doctor for Harlequins, to cut his lip to provide an alibi. After some hesitation, Dr. Chapman made a small cut in his mouth. Later, when asked about the incident, she testified that a loose tooth had caused the cut.

But a video of the game showed Williams taking the capsule from his sock, putting it into his mouth before the "blood" appeared, and winking at his teammates as he came off the field. The true story came out. Dean Richards, coach of Harlequins, was barred from coaching in the European league for three years. Steph Brennan, the trainer who gave the fake blood capsule to Williams, was suspended for two years. The team was fined 259,000 pounds. And, in September 2009, the UK General Medical Council suspended Dr. Chapman for a year.

At her recent hearing, Dr. Chapman testified that she was awaiting surgery for breast cancer at the time and was suffering from depression at the time, which impaired her judgment. She was deeply ashamed of what she had done and "horrified" that she had lied about her actions.

The GMC could have made the loss of medical licensure permanent, but elected to let her resume practice. The chair of the GMC panel said "Normally such misconduct could be expected to result in a finding of impaired fitness to practise.. However, the circumstances of this case are wholly exceptional in that the expert medical evidence suggests that in the absence of depression you would have not acted in this way." Apparently her prior performance had been without blemish. The GMC interpreted her actions as an aberrant, one-time matter.

In one of my posts about sex between doctors and patients I explained what makes the relationship unethical as follows:
Developing a sexual relationship with a present or former patient tarnishes the profession itself, whatever its effect on the individual patient. Harm to the patient is a probable outcome of doctor-patient sex. But harm to the profession is an inevitable outcome. Patients, the public, and physicians themselves, will lose trust in and respect for the medical profession.
I think the GMC came to the correct conclusion about Dr. Chapman. Assuming that her ethical lapse in the Williams situation was not part of a pattern of unethical behavior, and that her performance as an emergency physician met clinical and ethical standards, there is no reason to see her as a risky bet for future patients. And the harm to public perception of the integrity of the medical profession is not the same as with a sexual relationship. Dr. Chapman's lapse showed human frailty, but did not represent self-gratification or potential exploitation of a patient. A year of suspension and a full public apology is enough.

(To read more about "Bloodgate" itself, see here, here, and here.)

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