Last week it was reported that a doctor who had made mistakes in over 20 operations was returning to work. The doctor in question, Gideon Lauffer, made some serious errors while practising as a general surgeon, including two which led to the deaths of patients. In 2007, Mr Lauffer accidentally perforated the bowel of Terry Harris, a previously fit and healthy 68-year old, during a routine gall bladder operation, and Allan Scammell died from blood poisoning after Mr Lauffer sewed his bowel to the wall of his abdomen, also in 2007.
The General Medical Council recommended that Mr Lauffer be struck off, but the ultimate decision was in the hands of an independent panel. The panel decided to suspend Mr Lauffer for a period of 6 months, and then to allow him to return to medical practice with strict conditions imposed. He is now working at St. Thomas’s hospital in London, where he is practising as a junior A&E doctor. He is being retrained, working under the close supervision of consultants, and the GMC maintain close contact, keeping his case under review.
Unsurprisingly, considerable controversy surrounds Mr Lauffer’s return to work. The Times ran with the story on its front page last Thursday, describing his return to work as a ‘scandal’. The Daily Mail wrote of ‘fury’ at the surgeon’s return to work and the Telegraph said the case raised questions over the GMC’s ability to protect patients.
Mr Lauffer took the opportunity of the media attention to apologise to his former patients and their families for the mistakes he made. I completely understand how those who lost loved ones as a result of Mr Lauffer’s errors might feel that he should be permanently banned from being a doctor. However, the decision to allow him to undergo retraining, and then to return to medical practice - as a physician as opposed to a surgeon – is not obviously wrong, and raises important ethical and social issues.
It is tragic that two people died and others suffered as a result of Mr Lauffer’s incompetence, but I do think it is important to remember that his actions were mistakes and not deliberate. He may have shown himself to be an incompetent surgeon, but that does not make him a criminal.
Being an incompetent surgeon doesn’t make you an incompetent physician any more than being a poor court room advocate prevents a lawyer from being able to offer clients the best legal advice.
Being an incompetent surgeon doesn’t make you an incompetent physician any more than being a poor court room advocate prevents a lawyer from being able to offer clients the best legal advice. If Mr Lauffer is an entirely competent physician, and if it is possible for him to retrain in non-surgical medicine and be able to practice safely, then why should his past mistakes prevent this?
There are two important issues here, which need to be distinguished – protection of patients and retribution.
As far as protecting patients is concerned, provided that Mr Lauffer is banned from surgery, and that he receives proper training and supervision, there is no reason to believe that his failings as a surgeon make him any more of a risk to his future patients than if he had never practiced as a surgeon at all. As far as retribution is concerned, he has not been convicted of a crime – his poor surgery was negligent – and the remedy is compensation through the civil courts.
Unless a medical practitioner has committed a crime, I think it is absolutely right that regulatory panels base their decisions on forward-looking considerations, and not be guided by principles of retributive justice.
Unless a medical practitioner has committed a crime, I think it is absolutely right that regulatory panels base their decisions on forward-looking considerations, and not be guided by principles of retributive justice.
There is, however, a sting in the tail. Mr Lauffer was in fact disciplined not just for performing incompetent surgery, but also for performing an operation knowing he had not had appropriate training, for covering up his lack of training, and failing to admit (in the case of at least one operation) his mistake.In my view, if a doctor lacks professional judgement, or is shown to be dishonest, this almost certainly renders him or her unfit to practice as a doctor in any branch of medicine. So, although I think the treatment of this case by the press was pretty scandalous, I’m not convinced that Mr Lauffer ought to be continuing his medical career at all.
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In your conclusion you make the comment “you are not convinced Mr Lauffer ought to be continuing his medical career at all?” This differs from your premise? The question I ask is would you want him to be your medical physician in an emergency?
In your article you raised both ethical and social issues. Firstly you appear to be oriented towards Mr Lauffer continuing medicine as a nonsurgical physician. Stating his mistakes were not deliberate; questioning whether this mistake makes him a criminal? However, your ‘sting in the tail’ conclusion puts doubt in your premise. I consider the ‘sting in the tail’ and the lack of Mr Lauffer’s professional judgement to be the most important fact in this case. As an ethical issue, this should be in the forefront of the discussion.
When I started reading your article I had no doubt from the inception that Mr Lauffer should not be continuing in medicine, especially in an emergency hospital. Let me explain why I have this point of view. When graduating from medical school, Mr Lauffer took oath as a professional in medicine. This oath includes “Primum non nocere” (first do no harm; considered one of the primary ethical principal of medical practice) (Pharmacol 2005) towards patients. When entering any profession you take an oath to comply with a code of ethics; this is a guide of the values and conduct laid down by their professional body. Does working to a code of ethics result in professional and personal integrity or is it merely “just following the rules” (Davis 1999), Can a person be taught good professional judgement or is it part of a person’s character? I believe the code of ethics goes beyond legalism. A professional in the medical field has a responsibility to many stakeholders, these being his patients, employers, medical authorities and the community.
I agree that mistakes are made in all professions and you make the comparison to a lawyer not being able to offer his best legal advice. Each profession has their own codes of conduct and ethics drafted for their particular field and I believe you cannot compare. For example, in a court room one person does not make the decision on a person’s future it is up to a judge and jury. Unfortunately in an operating room this is not possible, therefore the decision lies solely on the surgeon’s personal judgement. As stated by Wakin “professional integrity begins with necessary responsibility to serve the fundamental need of the community”. (p26) (Wakin, 1996).
You state in your article; “because Mr Lauffer was an incompetent surgeon this does not make him an incompetent physician”. This may be true but were these mistakes due to his incompetency as a surgeon or his personal and professional integrity. Aristotle believed a person that showed virtuous traits was honest, kind, generous in character. Someone with personal integrity is someone who portrays these virtues. These virtuous character traits are not forced but part of the person’s habit and actions (p36). The virtue ethicist would say that someone going against these virtues is immoral and therefore unethical. In my opinion I would say Mr Lauffer showed vices of dishonesty and over ambitiousness. The Kantian theory would require the action to be categorically imperative, in other words; would it be made universal law that an under qualified person perform surgery? No, then under Kantian theory this action is immoral. The Utilitarianism would argue that the “greatest number for the greatest happiness” be applied. To apply this theory is difficult as Mr Lauffer was not to know the outcome of his errors. But he did know that he was not qualified to undertake this operation. The risk he took in continuing to operate until he was stood down was definitely not creating any happiness with anyone. Comparing Mr Lauffer’s behaviour to the ethical theories, he exhibited a lack of personal integrity. I do not think any ethicist would agree with the decision that Mr Lauffer made to perform those operations.
With reference to ‘proper training and supervision’; can the supervision be carried out logistically and is there a time when no amount of training will change a person’s character? We all know that hospital staff; especially accident and emergency, are under a huge amount of pressure. Can the medical profession guarantee that in this environment that Mr Lauffer is going to act with personal integrity? These are questions for the medical council to consider for the safety of patients.
This leads me to the professions integrity and the other issues mentioned by you; protection of patients and retribution. As a patient and the greater community we trust in the medical professions integrity and that they will act in our best interest. The British Medical Association in the UK require all doctors when the graduate to swear to the “Hippocratic Oath”, this is the basic ethics of medical practice and lays down a moral code of conduct for doctors. I will not list the promises that are required to be made, but one does stand out to me and that is to leave surgery to surgeons. If the profession has professional integrity; upholding values and standards they should uphold these values and show retribution if broken. “When fellow surgeons bury the mistakes of their incompetent colleagues rather than expose these colleagues and remove their licence to practice, they fall short of their responsibilities to the goals of the profession”. Wakin (1996)
The ‘sting in the tale’ gave me no doubt that Mr Lauffer should be permanently stood down.
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Brig Gen Malham M. Wakin once stated in the article he wrote called Professional Integrity for Air Power Journal (1996) that “we want to live in a world where the duties of a competent professional can be carried out by a good person with a clear and confident conscience” (p.28). Although this may not be necessarily true among the professionals in this day and age, most of the members of the society, including myself, still holds on to the belief and idea that the medical professionals in our society are competent and knowledgeable in the specific medical discipline in which they choose to practice in. Also, the society places great expectations and utmost trust on the medical councils governing the medical professionals in ensuring that their practicing members have been thoroughly trained, and exercise personal and professional conduct and integrity in providing the medical services the society needs. It is, therefore, not surprising that there was a public outcry and fury surrounding Gideon Lauffer’s reinstatement into the medical profession despite over 20 cases of his gross negligence as a general surgeon that compromised his patients’ health and lives. He has betrayed the trust that the society bestowed upon him and upon every practicing medical professional not only because he was simply incompetent in general surgery but also because he did not have the personal and professional integrity to admit to himself and to his profession that he was not capable and competent enough as a surgeon which cost his patients’ well-being and claimed a couple of their lives.
Wakin (1996) discussed that integrity is the term (or virtue) we now use to describe consistently knowing and doing the right things. Lauffer displayed the lack of personal integrity because he failed to acknowledge that, by knowingly denying his surgical incompetence, he had placed his patients in an even greater risk, and also because he personally ignored being honest and truthful enough to seek more training and guidance in the areas he was not up to the standards (of competency) in. He, instead, consistently dismissed a basic moral principle that we rational beings owe to each other not to harm others or put them in harm’s way.
Wakin (1996) also suggested that, aside form exercising personal integrity, professionals should also include role-specific obligations and responsibilities inherent in their particular professions towards the society. Lauffer exhibited his lack of professional integrity as he chose to disregard his social and professional obligations to abide by the conduct and values of his profession, as stated by General Medical Council, to protect the public, to be honest, and to be committed to excellence. He basically threw those professional values out the window when he intentionally ignored his surgical shortcomings and chose to carry on performing surgical procedures at his patients’ expense.
It is also not surprising that the public was pointing a finger at the General Medical Council not just because of Lauffer’s reinstatement as a junior A & E doctor but also to question the levels of standards of training and evaluation the medical council has set for the profession. Medical legislation and the society expect that high enough standards should have been set by GMC during the learning and training of medical practitioners and continuous evaluation of their performance and competency as they are practicing various medical disciplines. And rightfully so since the medical profession, unlike any other profession, deals with people’s health and lives and, therefore, have extremely high risks when mistakes and negligence occur particularly in the surgical area. This unfortunate event begs to question how Gideon Lauffer got the license to become a surgeon in the first place and how he was still allowed to operate on patients after his earlier surgical mistakes. GMC wanted a much harsher punishment for Lauffer and disallow him to practice medicine in any field but the decision to reinstate him into the medical profession was a decision made by an independent panel.
Whatever the basis or criteria used by the independent panel chosen to investigate his medical misadventures were and whatever the circumstances or reasons for his gross negligence were, I agree that Gideon Lauffer should not have been allowed to practice any discipline of medicine anymore because of his lack of professional and personal integrity and responsibility, and because he had compromised far too many patients’ health and lost two too many lives for his negligence and mistakes and, in the process, destroyed the society’s trust. Although Lauffer is not legally guilty for any crime or intentional malicious acts, he is, in my opinion, morally guilty of intentionally putting other people’s lives and well-being at more risk than necessary and professionally guilty of intentionally failing to achieve or maintain the level of medical competency and conduct required in the practice of medicine.