A Question of Ethics

It is the duty of every physician to treat those who come to him for help. Is it also his responsibility to turn in those patients who are sought by law-enforcement authorities? The question is more than academic. At the FBI's request, two medical journals published under American Medical Association imprimatur have printed "wanted" notices soliciting doctors' help in catching a suspect. This odd procedure raises serious ethical questions about the physician's responsibility to his patient.

In the February issues of the Archives of Dermatology and Archives of Internal Medicine, the articles ask for assistance in finding Roberta Brent Smith, 27, who is under indictment for conspiracy to transport illegal explosives across the Arizona-California state line. There is a detailed physical description and explanation of why the request is being directed at physicians: Smith suffers from severe, chronic acne that may cause her to seek medical attention.

Adjunct G-Men. Publishing requests for assistance in catching criminals is hardly new. Both the FBI and an A.M.A. official insist that medical journals have occasionally been so used in the past and will be in the future; indeed, the current issue of the A.M.A. Journal notifies doctors of another woman being sought by the Bureau. Nor does the confidentiality of the doctor-patient relationship, which covers only medical matters, excuse doctors from the demands of the law. In many states, for instance, doctors are required to report gunshot wounds, and in some they must also alert authorities to suspected cases of child abuse. Certain communicable diseases, including syphilis and gonorrhea, must be reported to public health authorities.

A.M.A. officials see no conflict in running the wanted notices in the organization's publications. Dr. Hugh Hussey, chief of the organization's division of scientific publications, maintains that the decision to publish the articles was made purely on editorial grounds and did not pose any question of ethics. Nor can Edwin Hoiman, secretary of the A.M.A.'s judicial council, find anything wrong with the notices. "Doctors have a civic responsibility," he says, "and it is a decision that the individual doctor has to make as to whether or not he is to call the law." On the other hand, Psychiatrist Willard Gaylin, president of the Institute of Society, Ethics and the Life Sciences in Hastings-on-Hudson. N.Y., points out that "Whether or not the article is ethical can be debated, but surely ethics are involved."

Gaylin, who is also a professor of psychiatry and law at Columbia University, points out that if, unlike Smith, the wanted person has a medical condition that is possibly fatal, fear of being turned in could deter him from seeking a doctor's attention. "What if, in the next instance of this," asks Gaylin, "the alleged criminal has a heart condition?"

The moral muddle aside, there is also a legal question: Is a doctor who reads the articles about Smith and then finds her in his waiting room legally obligated to call the FBI? Apparently not. State and federal law make it a crime to hinder the police or actively aid criminals to remain at large. The statutes generally impose no penalty for mere failure to report.

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