What are the wrong-making features in this case? These are what seem to be the relevant details:

“According to British news reports, Mr. Bramhall, 53, admitted to using an argon beam — an electrified gas jet that liver surgeons typically employ to stanch bleeding or to mark an area of operation on an organ — to etch “SB,” his initials, onto the livers. Argon beam marks are usually not harmful and would normally disappear. But they were apparently discovered by a colleague when one of the patients underwent a follow-up operation.”

Suppose instead he had sewn a suture in a distinctive way, his “signature style.” Would that too have been “assault”?

7 Replies to “Ethics in the News: The Initials-Etching Surgeon

  1. I see the distinctive suture case you mention as disanalogous in that it, but not the initials, is part of medically useful treatment, as opposed to having nothing to do with such treatment. But it may be that there is no harm here. But still, the doctor cannot do even harmless medically unnecessary things to one just for a chuckle.

  2. The *signature* stitch isn’t part of medically useful treatment either. So I doubt that that aspect is relevantly disanalogous.

  3. The GMC: “In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall’s registration, it is necessary in response to issue this formal warning.”

    The prosecutor: “…an intentional application of unlawful force to a patient whilst anaesthetised…His acts in marking the livers of those patients were deliberate and conscious acts…Suffice to say, for current purposes, these pleas meet the broad public interest.”

    Would the colleague have set the machinery in motion, given that there were probably no repercussions to patient health, if he had thought assault charges likely? The acts were witnessed by those assisting at the procedures, but I presume they will avoid criminal prosecution.

  4. Interesting case!

    Isn’t the most obvious wrong-making feature that others shouldn’t interfere with your body without your permission, even if it is harmless? (Perhaps this is because you own your body, and others can’t interfere with your property without your permission.) That said, if this is right, I’m not 100% sure whether “assault” is the right way of categorising this kind of wronging.

    With respect to the signature suture: The patient did not consent to the surgeon adding his initials. But, plausibly, they had consented to being sewn up, indeed, to being sewn up in any reasonable manner, where this might (or might not!) include the “signature” suture you mention, depending on how extravagant it is.

  5. Intuitively I find this very objectionable but, contrary to some of the other suggestions, I think my reaction is based largely on the fact that it was his initials that he etched in particular. If it had been a peace sign or a clover, or his child’s initials, it would not elicit (in me) a reaction of the same magnitude. I’d be interested to know whether others agree. I’m unsure whether the fact that it was his initials in particular is morally relevant is, though. Perhaps it feels particularly disrespectful as it amounts to a sort of branding or tagging of the patient’s body, in the manner typically we do to things that we own.

  6. This is interesting, Thomas. I think I share your intuition, at least to the extent that a signature occasionally implicates ownership. Can we lessen the distinction, though, between the peace sign/clover and the initials if we think of the initials in the way an artist signs a painting, rather than in an ownership signature? Not “this is mine” but rather “I did this.” (This was basically my aim in advancing the alternative of the “signature stitch.”)

  7. David: For what it’s worth, the “I did this” meaning does, to me, seem to make the tattooing less objectionable. I still can’t help but find it much more problematic than the ‘signature stitch, though. Perhaps the difference is that the signature stitch would, if not performed, we can assume, have been replaced by a different stitch, while this is not so of the tattoo. If a surgeon’s “signature” was to add a few fancy sutures beyond what was necessary, that seems different to me from simply doing different but equivalently efficacious stitches in a signature style. It’s interesting how these little nuances appear to make big intuitive differences–on the one hand that observation itself makes me think that the judgments are not tracking fundamental moral principles but something contingent or otherwise “yucky”, but perhaps there’s something behind it. What do you think?

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