AMA: doc as cop?

[Peter Marshall <techdiff@ix.netcom.com>]

PRIVACY Forum Digest     Sunday, 12 December 1999     Volume 08 : Issue 19

	        (http://www.vortex.com/privacy/priv.08.19)  

        
Date:    Sun, 12 Dec 99 10:37 PST
From:    lauren@vortex.com (Lauren Weinstein; PRIVACY Forum Moderator)
Subject: Your Doctor: Healer or Policeman?

Greetings.  Should your doctor's tools of the trade, such as stethoscope,
blood pressure meter, and other sundry tools, be supplemented
with the addition of handcuffs?  Some AMA delegates seem to think so.

At last Tuesday's meeting of the AMA (American Medical Association), a
majority of the delegates voted in a change to the AMA's ethical guidelines,
with potentially far-reaching ramifications.  The change modifies the
guidelines to permit (some would say encourage) doctors to notify state
Department of Motor Vehicles officials if their patients appear to be 
"risky drivers" in various manners.  On its face, many might say that this 
seems reasonable--get the dangerous drivers off the road.  But the 
devil is always in the details.  While alcoholism and senile dementia are 
specifically mentioned as two examples to justify the prioritizing 
of public safety over patient confidentiality, the risks of such 
a policy should be obvious.  

Exactly how are such determinations to be made by doctors?  Is every person
diagnosed as an alcoholic a risk?  For that matter, a range of other
conditions can impair driving ability.  Users of antihistamines
may become drowsy.  An ear infection could cause dizziness.  Diabetics who
misjudge their insulin could faint.  The list is almost endless.  Since
individual doctors will be making these decisions, a lack of uniformity
regarding who gets reported for which "impairment" seems very likely.

This seems to be a *major* change in the AMA's ethical guidelines, which up
to now have only sanctioned reporting of this sort in cases such as direct
threats of serious bodily harm against individuals, knife and gunshot
wounds, and certain communicable diseases (AMA Ethical Guidelines Section
E-5.05).  It's interesting to note that this section (before the recent
change) does not appear to include reporting of drug abuse (other sections
encourage doctors to direct such individuals to treatment programs).
Presumably drug abusers (however one might choose to define them, including
abusers of either illegal or legally prescribed drugs) would also fall into
the category of "impaired" drivers requiring reporting to authorities,
opening up a range of legal complexities.

Nobody wants truly impaired drivers on the road.  More frequent testing of
some categories of drivers (based on driving record, age, etc.) at license
renewal time would seem to be one prudent measure.  But the new AMA policy
seems to be a slippery slope indeed.  It might well have the major result
of discouraging people from seeking medical help, which could lead to minor
conditions becoming much more serious, where they perhaps could truly become
significant public health or safety concerns.

The current (prior to this recently voted change) AMA policy
concerning patient confidentiality can be viewed at:

http://www.ama-assn.org/physlegl/legal/patient.htm

Also, the entire "AMA PolicyFinder" (again, prior to the recent change) is,
at least for now, downloadable for Windows users as a searchable database,
from:

http://enet.ama-assn.org/public/policyf/ama_a99.exe

It's fascinating reading.

Coming soon to the PRIVACY Forum: Will calls to reduce medical
mistakes result in major increases in medical database abuses?
Stay tuned.

--Lauren--
lauren@vortex.com
Lauren Weinstein
Moderator, PRIVACY Forum - http://www.vortex.com
Co-Founder, PFIR: People for Internet Responsibility - http://www.pfir.org
Member, ACM Committee on Computers and Public Policy

------------------------------