Where I Stand — Mike O’Callaghan: Nevada’s medical ethics

Thursday, Oct. 8, 1998 | 11:05 a.m.

WOULD YOU TELL everything to your doctor knowing that it could appear on television or in a newspaper that evening? Would you even consider going to a doctor for a physical or mental problem if you couldn't trust him or her? I doubt if any of us would go to a doctor we can't trust.

The American Medical Association Code of Medical Ethics states that "The confidentiality of physician-patient communications is desirable to assure free and open disclosure by the patient to the physician of all information needed to establish a proper diagnosis and attain the most desirable clinical outcome possible. Protecting the confidentiality of the personal and medical information in such medical records is also necessary to prevent humiliation, embarrassment, or discomfort of patients. At the same time, patients may have legitimate desires to have medical information concerning their care and treatment forwarded to others."

This ethical charge goes all the way back to the Oath of Hippocrates before the time of Christ. Thomas Percival's code of medical ethics reaffirmed the need for medical confidentiality in 1803 and from that came the AMA's first code of ethics adopted in 1847.

A recent letter from Massachusetts General Hospital demonstrates that its professionals still treasure the physician's code of ethics. Very simply, no matter how much the Nevada State Athletic Commission wants to make public the contents of the mental exams given heavyweight boxer Mike Tyson, the hospital is resisting.

It was the NSAC that recommended Tyson be given an extensive battery of tests to determine if he is fit to return to the ring after biting his last opponent 15 months ago. Massachusetts General Hospital was one of three facilities the commissioners told Tyson he could use for the tests. At the end of the six-hour hearing, Tyson agreed to undergo the exams and have the results turned over to the commission. It's for their use in making a decision on Tyson's future in the ring. Then a state attorney made clear that anything given the commission had to be made public.

Dr. Ronald Schouten wrote a letter to Dr. Skip Homansky, who is chairman of the NSAC Medical Advisory Board, and told him the testing team would answer the five questions about Tyson the commission asked. Prior to testing, Dr. Schouten made clear the ethical concerns the hospital had about how the report would be used. He left little doubt about the high ethical standards of his hospital when writing, "First, we believe that revelation of Mr. Tyson's diagnosis in a public setting where it could be released to the public at large is unnecessary for the purposes of the commission's determination of his fitness to return to the ring. Most importantly, we believe that this would be harmful to Mr. Tyson and contrary to his best clinical interests. We are not opposed to revealing Mr. Tyson's diagnosis to the Athletic Commission, if that is agreeable to Mr. Tyson and if the commission feels it is necessary for its internal use. ...

"Second, it is our intention to release only that information regarding Mr. Tyson's medical history, personal and social history, and discussions with us which we feel is absolutely essential to the determination to be made by the commission."

Dr. Schouten's letter then reminded the Nevadans that "psychologists in Massachusetts are under an ethical obligation not to release raw data from their reports except to other licensed psychologists. Therefore, we will not be releasing raw data, nor will we be releasing copies of the full psychological and neuropsychological test reports for public dissemination. We will refer to the results of those testings in our final report in which we will address the five questions raised by the commission. ... "

Last week, Las Vegas attorney Jim Jimmerson went to District Court before Judge Gene Porter with a plea to protect Tyson's records from media and public scrutiny. In his pleading, Jimmerson told the court "there is no true and genuine public interest which would outweigh the harm to plaintiff in releasing these records. Clearly the media may seek these records to satisfy the public's morbid curiosity regarding plaintiff, and may oppose their confidentiality, yet many media members also find disclosure of these personal records abhorrent and truly unnecessary. ... However, simply because there is an appetite to disregard a person's privacy does not mean this court should sate it. Perhaps the public needs to look inside themselves to decide why they would want access to this information. ..."

Jimmerson's plea didn't fall on deaf ears. Judge Porter told him "I don't think it does him any good, or the public any good, you know. I mean, I mean, I agree with you a hundred percent. I don't think the man's personal history and his life are anybody's business but himself. And why the Nevada Athletic Commission took this course of action, I don't know. And I can't speak for them. But they've got the statutory power to do it, and they did it. ..."

Now the issue of Mike Tyson's medical records is before the Nevada Supreme Court. Nevadans should be more concerned about the issue of privacy of medical records than whether Tyson fights again. His future in the ring will be determined by the NSAC. If this determination is made by spreading his mental test results over front pages, thousands of fellow Nevadans will be the losers now and for years to come. At least the professionals in Massachusetts show the wisdom of protecting the patients and their profession by withholding raw data. We can only hope the medical ethics of Dr. Schouten and his fellow professionals will somehow rub off on the people making decisions in Nevada.