Wednesday, September 29, 2004

Boundary dispute.

The Miami New Times will publish a piece on Thursday that raises troubling questions of possible boundary violations by a physician. We're not talking about a property dispute over a fence line, but the kind of boundary defined by medical ethics. A physician shouldn't have a romantic or sexual relationship with a patient she or he is treating; that's a boundary violation, crossing over a line that defines the outer limits of the physician-patient relationship. Patients are presumed to be vulnerable and desperate and therefore not in a good position to exercise reasonable judgment or to freely consent or refuse to consent to the conduct in question.

The article focuses on a different type of boundary dispute: money. Specifically, it says that the families of two patients of a physician are contesting their decedents' wills -- which left sizeable portions of their estates to their physician -- on the ground of undue influence. In three cases detailed in the story, the paper reports the following pattern:
All [three women] spent their adult lives in Miami. All of them had been married, but had no children. All lived into their nineties, widows left to grow old in magnificent, rambling houses, beyond whose doors they rarely ventured. All of them left behind estates worth hundreds of thousands of dollars. All of them had employed Dr. Aloysius "Al" Brady as their primary care physician.

When they died, all of them left Brady a significant portion of their estates, or control of the estates.

Sixty-six-years-old, tall with long limbs, and a cadaverous complexion right down to his bone white hair and mustache, Brady has established a pattern of becoming the most important man in the life of women with surprisingly consistent backgrounds: wealthy, childless, frail, nonagenarians.

It appears he accomplished that by making more than just house calls. He bought them groceries and offered to manage their checkbooks, even if there were already people performing these tasks. He also stopped by for cocktails and bought dinner and flowers. In short, say family and friends, who described all of the women as homebound and lonely, he charmed them.
The doctor's lawyer denies the charges. The facts may or may not bear out the accusers' claims, but the cases stand as an illustration of an important ethical principal:
"Another clear rule [says Kenneth Goodman, co-director of the University of Miami's ethics program, and director of its bioethics program] is that you don't borrow money from your patients, and you don't insinuate yourself into their wills. Any time you find yourself in a patient's wallet or checkbook for anything other than a fee, you've gone from practicing medicine to doing something altogether different."

posted by tommayo, 8:24 PM

Health care law (including public health law, medical ethics, and life sciences), with digressions into constitutional law, poetry, and other things that matter