Thursday, June 16, 2011

Should a Convicted Rapist be Allowed to Practice Medicine?

In 2008, a military court convicted Dr. Mark Seldes, a Flight Surgeon serving in South Korea, for raping a civilian colleague. Dr. Seldes served three years in prison. When he emerged from incarceration he applied for reinstatement of his Florida license. Two weeks ago, the Florida Board of Medicine voted to allow Dr. Seldes to return to medical practice.

Here's the gist of the Health News Florida article about the board's decision:
Board members wrestled with the question of whether a rape conviction precludes a health professional from being able to practice with skill and safety, as Florida statutes require.

The rape victim was not a patient, and thus Seldes's attorney, Kenneth Haber, said the case had nothing to do with the practice of medicine. Haber also said that the rape offense was not violent and that Seldes had previous sexual contact with the victim before the rape. An account of the case in Stars and Stripes said the rape victim was asleep, under medication, at the time the assault occurred.

“He was a man who made a terrible mistake to engage in a relationship with an individual who was not his wife, and has destroyed his career and has certainly brought dire consequences on his marriage,” Haber said.

Seldes's wife sat next to him as the Board went back and forth over what conditions Seldes must meet in order to return to practice.

"Anytime the word rape is used, it rises to a level that gives me great concern, and I'm unwilling to say that this doctor should keep practicing in Florida," said Don Mullins, a consumer member of the board.

"I take a different view," Dr. Zach Zachariah shot back. "In my personal opinion, he has paid his penance."

The board ultimately agreed that Seldes could practice, as long as he works in a government facility while he is under supervision by PRN, a monitoring program for troubled physicians.

He must also complete at least 300 hours of community service within the next three years and give all patients a questionnaire that asks how they had been treated. Seldes requested not to be placed on official "probation," since that might prevent him from being able to get a job with the VA or some other agency, and the board agreed.
If the only question the board had to answer was whether Dr. Seldes would be able to "practice with skill and safety," they could examine him the way candidates for board certification are examined and see if he passed.

But that's not the criterion physician Zach Zachariah and consumer Don Mullins were using.

Zachariah believed that by serving his jail sentence, Seldes had "paid his penance." From the perspective of justice, Zachariah is right. We should help ex-convicts reenter society and become constructive citizens. Jesus's teaching - "let he who is without sin cast the first stone" - deserves universal respect.

Mullins didn't challenge the idea that Seldes had "paid his penance," but he believed it simply didn't make sense to give a rapist a medical license. He was also right.

From the perspective of ethics, predicting Dr. Seldes's ability to perform with "skill and safety" isn't the only question. The Hippocratic oath includes this sentence: "In purity and holiness I will guard my life and my art." Anyone who has committed rape has not guarded his life "in purity and holiness." This is the value Mullins guided himself by, and he was right to do so.

If medical practice were simply a form of body repair, analogous to plumbing, tiling and painting, the Hippocratic precept would not apply. But medical care is built on a relationship and stands and falls with trust. And it isn't just the individual physician who must be trusted - it's the profession itself.

The Florida Board of Medicine made a serious error when it concluded that rape doesn't disqualify a physician from being part of the medical community.

(For a post about the question of whether someone who had been convicted for murder should have been accepted into medical school, see here.)


Anonymous said...

Does this paragraph from the report contain a contradiction?

"The rape victim was not a patient, and thus Seldes's attorney, Kenneth Haber, said the case had nothing to do with the practice of medicine. … An account of the case in Stars and Stripes said the rape victim was asleep, under medication, at the time the assault occurred."

Did Seldes prescribe or administer the medication? Even if he did not, did his status as a physician make him responsible as a physician for being aware of and for respecting the victim's helplessness?

Jim Sabin said...

Dear Anonymous -

As I understand the situation, the Dr. Seldes did not administer a medication. The victim, who he knew, and with whom he'd had previous sexual contact, was drinking and had taken a sleeping medication. She reported waking up briefly with Dr. Seldes on top of her, and then later finding a condom in her trash. The defense argued that the sex was consensual. The military court decided otherwise.

I agree completely with your view that he should be held responsible "for being aware of and for respecting the victim's helplessness." I believe that standard should be applied to all people, but that it has distinctive application to a health professional.

Thank you for your question!



Anonymous said...

Do any violations of the Hippocratic oath render a physician unfit? This seems like an unreasonable standard.

Jim Sabin said...

Dear Anonymous -

Your raise an interesting and important question - namely, what is the standing of a 2500 year old medical oath?

The oath continues to be cited (as I did in the post) for two main reasons. First, it expresses health care values that can be seen as "timeless." The words I quoted - "In purity and holiness I will guard my life and my art" - convey a sense that would-be healers should be people of integrity. Second, being able to cite words from an ancient physician strengthens the case for the legitimacy and force of the basic values the oath asserts.

In other words, it's because the oath agrees with contemporary values that it continues to be cited. It's not literally seen as a sacred, revealed text, but rather as a recognition of basic moral truths about the healing professions.

The oath includes this promise - "I will not give a lethal drug to anyone if I am asked." In Oregon and Washington, "physician assistance in dying" is legally sanctioned, and many physicians agree with that moral perspective. This shows that where contemporary views differ from the oath, the oath does not prevail.



Anonymous said...

Dr Seldes is now working out his 300 hours at the St Petersburg Health Department. The employees have been told that his past is confidential and is not to be shared with the patients on threat of termination....but do not leave him alone with a female patient.

Jim Sabin said...

Dear anonymous -

Thank you for the follow up information. What you report shows the dilemma the Florida board has created. Dr. Seldes is allowed to practice, but should not be alone with female patients. The dilemma is - Dr. Seldes may have excellent technical capacity for medical practice, but he's been convicted of a crime that seriously impairs a person's trustworthiness.

It's a tragic situation. An omniscient observer might see Dr. Seldes as a fundamentally good person who made a single catastrophic mistake that will never be repeated and that does not represent his true character. But ordinary mortals aren't omniscient, and as the framework you report shows, his trustworthiness has been forever impaired.