From the editor

SECOND OPINION
BY SIDNEY HARRIS

Ethical decisions are not always unanimous

As a former Yale house officer trained at Yale nearly 50 years ago, I want to congratulate the bioethics program described in the Spring 2004 edition of Yale Medicine [“Two Alternatives, Each a Little Wrong”].

In the case concerning the schizophrenic young man whose mother secretly medicated him, I agree with the attending physician. Although society does not surreptitiously medicate chronic street schizophrenics, in this case a dedicated caregiver (his mother) was available and, on balance, the medication given without the patient’s permission probably contributed to his improvement. Unlike the bioethicist, I would have been willing to cooperate with the mother’s wishes in this treatment of a very major medical disease.

I agree with the bioethicists in the other three cases.

Many thanks for this interesting discussion.

Donald P. Feeney, M.D., HS ’57
Rockford, Ill.


I agree with Dr. Zonana that the physician should not have colluded with the mother who secretly placed medication in the psychotic son’s food, even though the result was marked improvement in the son’s condition. It is also worth asking whether there might have been an advance directive in this case, in which the son, at a time when he was competent, expressed a preference for treatment. Is it possible that he had spoken in the past about the benefits of medication? Might he have even suggested that his mother hide his medicine in his food if he again became psychotic? While these are unlikely possibilities, they highlight the importance of considering the wishes an incompetent patient may have expressed when he was not psychotic. If the son had expressed a preference for medication, the ethical balance between honesty and patient autonomy on the one hand and clinical outcome on the other would have tilted toward treatment. In the legal realm, some jurisdictions are now recognizing health care proxies for psychiatric treatment.

Burns Woodward, M.D. ’71
Waban, Mass.

Max Taffel, a surgeon, not a neurosurgeon

I was sad to read of the death of Max Taffel [In memoriam, Spring 2004].

You reported that Dr. Taffel was a neurosurgeon. I believe you will find that he was a general surgeon.

Max Taffel was the most memorable of the excellent teachers I was fortunate enough to be exposed to at Yale Medical School from 1955 to 1959. He rarely missed medical grand rounds (despite the fact he was a surgeon) and he usually had something to say that was worth listening to and that demonstrated the great depth and breadth of his knowledge.

During World War II, he might well have been, as you reported, “the only neurosurgeon on … Saipan,” as a general surgeon. In my 31-year career as a military general surgeon, I did some neurosurgical cases myself (emergency head surgery for trauma) when the situation demanded it. But I think you will find that, at least when I knew him and scrubbed with him (while acting as a substitute surgical intern at Grace-New Haven Hospital), Dr. Max Taffel was a general surgeon.

Martin L. Fackler, M.D. ’59
Gainesville, Fla.


Dr. Fackler is correct. Max Taffel was a general surgeon who had received training in thoracic and neurological surgery.

From the Editor:

Seeing with new eyes

There was a moment, probably sometime in the mid-1980s, when my awareness of the politics of disability eclipsed my awareness of what it means to be disabled. The latter was never that developed, since I grew up without disability and had no close friends or relations who were disabled. But although my knowledge was second- or third-hand, I wasn’t indifferent. Like many others, I had been raised to appreciate the hardships and rights of disabled people, whom we knew then as “handicapped.” (The H-word had not yet been retired as politically incorrect.)

At a certain point though, I now realize, I must have lost a measure of empathy. This could have been the result of my own self-absorption or a reaction to the stridency of a particularly militant point of view I encountered somewhere; I don’t recall. All I know is that somewhere between my first job and third child, a thought nested in my consciousness that said, “Sure that’s hard, but life is tough all over.”

Gretchen Berland’s film Rolling changed all this.

Rolling, the subject of Cathy Shufro’s article (“Life on Wheels”), is powerful in the simplicity of its basic premise: Berland equipped three disabled people in Los Angeles with digital video cameras and asked them to record the events of their daily lives. The intimate, 70-minute film that resulted shows what it is like to depend on a wheelchair, and does so in a way that an objective, third-person documentary likely could not have. For me, the realization that life just isn’t as hard for most of us came when one of the three protagonists, Vicki Elman, was obliged to roll herself off the sidewalk and into city traffic in order to get around a carelessly placed newspaper box. The obstacle would have been insignificant to another pedestrian, but Elman’s solution put her life at risk. My new attitude was reinforced later in the film when Elman, who has multiple sclerosis, was stranded outside her home, alone as the sun went down, hours after a van driver, citing company rules, had refused to wheel her inside.

Rolling changed how I feel, but this was not the director’s first goal. Berland, an assistant professor of medicine at Yale who began the project as a Robert Wood Johnson Clinical Scholar at UCLA, says her initial purpose in making the film was to explore a rather unconventional research tool—the documentary film—and to produce new knowledge about disability in the process. “You can use the visual medium to explore aspects of a patient’s experience that we might not otherwise be able to capture using any other kind of data collection tool,” says Berland, who was a producer for NOVA and NewsHour before studying medicine. Her colleague Harlan Krumholz, M.D., calls the film a much-needed complement to huge analytical studies of clinical data that reveal patterns on a large scale but contribute little to doctors’ understanding of “the tapestry of what makes up [patients’] lives.”

If you get the chance to see Rolling, jump on it. One short clip may be viewed on our website, yalemedicine.yale.edu, and the film is being screened at festivals. In an era when politics have become increasingly polarized and we risk categorizing people as either “us” or “them,” Rolling reminds us in a straightforward and honest way of the common ground we all share as human beings. “There but for the grace …”

Michael Fitzsousa
michael.fitzsousa@yale.edu