Museum of Sex, New York City

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Physician Assisted Suicide (Euthanasia)

Physician Assisted Suicide (Euthanasia)
- by William Hay

The slippery slope!!!::: (this is where Holland’s Euthanasia program quickly moved onto.)
Hi I’m your psychiatrist.  Please answer the following questions:
1) Would you like to kill yourself?
2) Would you like to do it yourself?
3) Would you like me to do it for you?
4) Have you a preferred method of death? Poison? Drowning? Hanging? Gunshot?
5) Would you like it done as a private affair? (That’s  cheapest).
6) Or would you prefer a public affair? (It generally costs more if you want politicians to attend.
They’ve become very expensive these days.)
7) How much time would you like to think about it? A few minutes?  A day. Or two?

John 8: 42 NIV Study Bible

"If God were your Father, you would love me, for I came from God and now I am here. I have not come on my own but he sent me.  Because you are unable to hear what I say, you belong to your father, the devil, and you want to carry out your father’s desire. He was a murderer from the beginning, not holding to the truth, for there is no truth in him. When he lies, he speaks his native language, for he is a liar and the father of lies.  Yet because I tell the truth, you do not believe me! Can any of you prove me guilty of sin? If I am telling the truth, why don’t you believe me? He who belongs to God hears what God says. The reason you do not hear is that you do not belong to God.”
The message of Jesus Christ is that God is not some old white hair guy or gal sitting on a cloud directing the universe. The Cosmic Christ is God Immanent.  God manifested himself in the world.  His son, his image, his word are here and now with us.  That word is the word of truth.
To me that is as true as ‘scientific truth’.  The Creationist knows God first manifest himself in Nature before the Fall and before the Cross.  Within nature there is the perfection and messages found in the matter of fractals, in the triangle, in the hologram.  There are immeasurably signs that man and nature did not just happen but were conceived.  A monkey given time simply could not compose as does Bach. The Big Bang theory, a foundation of science, states that there is a ‘finite’ time from creation. Within that time, a monkey simply could not compose as Bach.  Countless other matters of creation could not have ‘evolved’ simply because there is not the amount of time for evolution to occur. Further the idea of mutation doesn’t take into account that most mutation is devolutionary not evolutionary.  Understanding science and string theory and quantum physics scientists see the hand of God. Even Einstein, a theorist, said ‘God does not play with dice.’  This life is not ‘random’ but there is purpose.
I believe my purpose in life is truth.  The language of truth is fundamental.  The deep evil of political correctness language, the language of the demonic, is that it confuses truth.  “My truth”, says the devil.  Of course we all know that there are many perceptions and many angles of vision and experience. Yet in the end, we agree on truth in science. It’s called objectivity. My truth is subjectivity.  Together we know more than as one. Together we can.  The irony and hypocricy and utter deceit of the left and politically correct is their fixation on the ‘consensus opinion’ of ‘climate change’ yet they themselves insist on the language of ‘my truth’.  The very truth was the thing of ‘consensus’ not an individual claim. The devil lies. The devil is deceit. There is a yes and a no.  We know all is grey but the ‘aha’ moment gives us insight and discernment so that no everything isn’t true.  There is truth.  It is from God. It is the truth of science and gravity here on earth. It is the truth of right and wrong. There is morality.
Smoking marijuana and drinking excessively there is a blurring of the world. Everything is okay.  This is not enlightenment but devolution to a lower level of non discrimination. A child puts everything into his mouth and learns that poisons are not to be taken. The drug addict is so accepting so ‘chill’, so ‘cool’.  ‘Take it easy, Man, everything is cool.”  No it’s not. That’s the devil speaking. That’s a lie.  Everything is not ‘cool’.  Maybe in some metaphysical way it is but right here and now the killing of a child would not be cool. Ironically if I offer to taken the drug addict’s drug, suddenly this generous easy going guru of enlightenment becomes more truthful. The same with the politicians and rich men and women who are generous with the goods, labour and money of others.  It is not that they are evil but they do seem to heed the devil more than they heed the father. They are leaders who lead from behind not those who charge with the troops.
The historical Jesus said he was from God and that God sent him.  Fundamentally I don’t know how I got here.  I know from stories I was born to my mother but I don’t even remember it. I don’t remember my time in the womb. I have a birth certificate.  I presume that I exist as Descartes so simply stated, “I think therefore I am”  (Cogito ergo sum).  But I don’t know if I spontaneously occurred or was sent. It’s an act of humility to consider that I might not have the capacity to ‘self create’.  I know about sperm and eggs and that whole biological cycle but it’s all ancient and truly mysterious and difficult and unpredictable and even sketchy in parts that there is today no ‘consensus’ on the ‘start’ of human life.  The abortionists, great lovers of the devil, rich ruthless men and women who are the greatest of murderers and deceivers who have argued that it is not murder to kill even a full grown child in the mother’s womb about to be naturally born. These men and women for money would kill babies and toddler if they could convince the world that they were good.  The devil is the great deceiver.  But no we don’t quite know with utter certainly if God invests the fetus with life at the moment of egg meeting sperm or perhaps later in the womb. Indeed religionists say that each life is ‘predestined’. This means that God meant for the birth to occur. God mean for the egg to meet the sperm and life to follow. God did not mean for abortion to occur.
In this scenario there is a life purpose, that is God and there is the death purpose that is the Devil’s.  Freud called this ‘life wish’, eros and death wish, thanatos.  The devil is murderous. This dichotomy of good and evil is of this world , where truth and lie exist.  There is night and day. There is evidence of particle and wave.  Flow and stasis.  Right and wrong. Truth and lie.  The language is not ‘my truth’ and ‘your truth’ but rather ‘my perception of truth’ and ‘your perception of truth’ otherwise these politically correct nut bars would have us saying ‘my light’ and ‘your light’ and the pc police would have you arrested if you insisted at midnight in utter darkness that ‘its’ night’ not ‘day’.
Language is the first casualty of war.  And don’t get me wrong, I believe there is a war.  The devil is in the detail. The politically correct speakers are demonic. They are liars. They would try to convince us that ‘black is white’ so we will accept that ‘your money is my money’ and ‘your life is my life’.  Political correctness in all it’s forms is evil.  
Jesus Christ was without sin. To sin is to ‘miss the mark’. It means ‘to sin’ is to err.  My intention when I shoot my rifle at a target is to hit the bullseye.  When I miss I have ‘sinned’.  To those who argue that all is ‘determined’ and ‘all is fate’ and that they have no accountability and no responsibility then there can be no sin. Yet I have observed these sinners all my life and they are very specifically willing to accept praise and reward for what they do but unwilling to accept punishment and blame. They are above the law. Their truth is narcissism. Their father is the devil.   They ‘change history’ to agree with what they want because they do not want to admit that their ‘purpose’ was other and that good came regardless of their intent. They would argue that ‘good things’ happen and ‘bad things happen’ and they were ‘lucky’ and you were ‘un lucky’.  They deny they ‘fix’ the games because they are liars.  The devil is a murderer and a liar.  If all is ‘accidental’ then the devil doesn’t have to be accountable.  They never accept responsibility for their behaviour but would rather ‘deny, deny, deny, lie, lie, lie’.
Now  the old language of the Bible is nonetheless a valid language. I can use the word ‘karma’ instead of ‘retribution’. I can put the language of Jesus into the California message of the Secret. I can talk about the first law of physics as God and the second law of physics as the devil. I can show the opposing forces in the universe physically and ask why there would not be opposing forces in man. I feel there is a ‘good’ way to do something and a ‘bad’ way.  If I want to build something I can do it with ‘efficiency’ and ‘least waste and destruction’ or I can cause the most havoc and crisis to achieve my end.  The idea of good and bad, or good and evil is throughout our world and our society. We question the decisions that serve the fewest and celebrate those decisions that benefit the most.
Increasingly there are bankers and financial folk who trade in companies and acquire drugs that cure and yet they price them at maximum profit and show no interest in the outcomes of their decision and how they would affect a sick child.  There is a back lash.  It’s karma. It’s Jesus. It’s Christ. Life’s a bitch.  But there seems to be a connection between kicking and mule and being kicked back.  We know in war that more people are killed by ‘friendly fire’ and the ‘stupid decisions of leaders’ than by the enemy bullets.  This push back is everywhere. This is ‘truth’.
Now the politically correct would lie and lie extensively.  Truth is truth. It’s not a possession. The new consumer society would say this is ‘my planet’. This is ‘my galaxy’. This is ‘my creation’. They sound like little children because they have not morally or emotionally developed. They are not diaper trained either.  Jesus recognized that the world was full of children and he loved the children.  So he said, “forgive them for they know not what they do’.  They are the tool of the devil. They are deluded. They are the zombies who are taken over by political correctness and other godless lies.
Of course it’s not ‘cool’ to think of the Devil as a serpent. Just like it’s not cool to think of God as a white haired elder out on a cloud. Just as God is immanent so is the devil. The devil is that which is inside you that is destructive. God is that which is creative. God and the devil are two voices inside each of us.
Jesus is asking which you will call your Father. There is choice. And you will be accountable.

Prisoner's Dilemma

Prisoner's dilemna is a game that is used to study cooperative and non cooperative behaviour.  In the out come analysis there are 4 possibilities:
1) You win, I lose
2) You lose, I win
3) We lose
4) We win.

When I first studied this a quarter century ago I was struck by the finding that most people are unable to achieve the we win solution because they must forfeit the I win you loose option to achieve we win. Hence more commonly people end up in the 'we lose' scenario.

The game is described as follows:

Two men are arrested, but the police do not possess enough information for a conviction.
The men are separated.
Police offer both a similiar deal.
- if one testifies against the partner (defects/betrays) and the other remains silent (cooperates/assists), the betrayer goes free and the cooperator receives the full one year sentence.
If both remain silent, both are sentence to only one month in jail for a minor charge.
If each 'rats out' the other, each receives a thre month sentence.
Each prisoner must choose either to betray or remain silent; the decision of each is kept quiet.
What should they do?

Trolley Car Moral Dilemnas

One of the tools used to question morality and ethical behaviour is the trolley car thought experiment.

Imagine that a trolly car is headed down the tracks towards 5 people.
Imagine a bystander who can switch the trolly car from the path to another?
Imagine that the other tracks have only one person.

Is it morally required for the person to switch the trolley car to the second track?
Is it morally permitted for the person to switch the trolly car to the second track?
Is it morally prohibited for the person to switch the trolly car to the second track?

What if the bystander was himself standing on the second track alone?

Would it be permitted, required, or prohibitted to switch the trolly car to this second track now?

What if you could push a fat man in front of the trolly car and that would make the car safely switch from track one to track two, albeit killing the fat man?

The answers that you make to these questions defines to some degree the basis one uses for making decisions.

The Confession John Grisham

John Grisham is a captivating writer whose knowledge of law is impressive. His story of the condemned man on death row with all it's uncertainty and ambiguity is a trying story.  Falsely accused or not the drama unfolds with police and woods and race riots.  In the midst of this are governors and pr and media ratings. All the while a young man waits and a lawyer fights for his case.  Families huddle and sometimes cry. There's not much laughter in the serious business of life taking but that's just what Grisham in this novel is bringing forward to the reader's attention.  It's all about the death penalty.  Should the state be in this business and what about the mistakes in the justice system, or rather given all the mistakes in the justice system.  What is Christian and what is American and what is finally Texan? Who would have known that the cost of killing was greater than the cost of living? A good novel and very thought provoking read if only for the actions taken. There is little wonder why John Grisham is a New York Best Seller.

Dr. Tamar Gendler and Open Learning Yale University

I downloaded the applications iTunesU for my iphone.  The selection of choices for the app in itunes was slim except for this truly remarkable presentation "Philosophy and Science of Human Nature" by philosopher Tamar Gendler.  Philosophy can be dry but Dr. Gendler enlivens it with present day relevance.  She uses the stories of Vietnam war politically decided 'point' soldier experiences to explore morality as discussed by Plato and Aristotle. She describes Milgram's experiments on decision making exploring the horrors of Nazi Germany with Aristotles learning of habits.  Happiness and pleasure are compared while in the midst of these discussions she gives delightful comments about her husband's experience at MIT, a bar mitzvah event or the education of her own children in comparison with the teaching of male philosophers who implicitly are not mothers.
For the last 2 weeks I've had the true pleasure of hearing a Dr. Gendler lecture each morning on the way to work in my car or returning home.
I am very thankful to Dr. Gendler for her erudition and exciting teaching capacity and itunes and Yale for enlivening my commute.  Thank you.

Morality for Appearances and the Ring of Gyges

In Plato, Republic Book II, the Ring of Gyges is a mythical artefact that allows the wearer to be invisible.  With invisibility granted by this ringer the wearer acted in an immoral way.  This was an example for the argument that people act morality not for an intrinsic morality but rather the appearance of morality as it instrumentally served them.
Psychologist Daniel Batson of University of Kansas did a series of empirical studies showing that students would 80% of the time be self serving and rate their morality in such cases as 4 on a scale of 1-10.  However if they were allowed to flip a coin and then do a self serving deed, this appearance of being 'reasonable' ie flipping a coin, resulted still in them acting selfishly 80% of the time but because they had taken the time to flip a coin, even though they ignored the results, this resulted in them seeing themselves as acting reasonably and justly, and rating themselves 6-9 out of 10 on the scale.
If a simple action such as putting a mirror facing them on in another experiment putting a pair of eyes was introduced people act less selfishly and more fairly.  The evidence is that most people act morally out of fear of shame.
I'm interested in the 20% who indeed appear to act morally from some more deeply seated sense.
However this speaks to the need for transparency in the courts and certainly supports the idea of television cameras in the court room at least for the masses.  We do this in parliament and despite back room deals this openess probably promotes greater morality.

Lawrence Kholberg and Stages of Moral Reasoning

Lawrence Kohlberg's Stages of Moral Development was derived from the work of Swiss Psychologist, Jean Piaget.  Piaget claimed that moral development coincided with the development of schema and stages of reasoning in other regards.
Moral reasoning (cognitively, socially and emotionally influenced, the basis of ethical behaivour was divided into six stages:
Preconventional level (morality is due to external controls)
Stage 1 - Punishment and Obedience; child`s limitted thinking bases moral decisions upon fear or self interest.
Stage 2 - Relativistic orientation; child moves from fear of punishment to concern for fairness, rewards obtained
               by bartering
Conventional level of morality (morality as rules for society`s order)
Stage 3 - Social approval
Stage 4 - Maintains laws of system; teen and adult move from preoccupation with what is ``fair`for individuals      
               to factor in conformity to society`s needs; social conscience
Postconventional principled level (morality as value defined)
Stage 5 - Society`s good paramount
Stage 6 - Universal ethics; focus on justice, fairness; recognition of other`s moral standards

Carol Gilligan asserted that male and female moral development diverged. She agreed with Kolhberg`s developmental until age 7-11 when she felt Ethic of caring in girls - Girl`s goals focuses upon compassion, relationships and responsibilities, not better but different from boys. She felt the Ethics of Justice in boys dominated with Boy`s goal bing rationally committing to moral ideals of justice.

An integrated approach to moral development saw five stages of conceptualization<
1) morality of restraint
2) morality of mastery
3) morality of virtuous striving
4) idealization
5) individual responsibility

The philosophical assumptions underlying were that his stages fit `moral reasoning`and not `moral conclusions`.  He insisted that the form and structure of moral arguments is independent of the content. In psychiatry this commonly described as `process``
Kohlberg`s theory centered on the notion that justice is the essential characteristic of moral reasoning.
He further considered that moral judgements could be evaluated logically.
According to Kohlberg one did not `skip`developmental stages but rather movd to higher level of moral reasoning by increasing competence.

In 1979, the Defining Issues Test, based on Kholberg,  was created by James Rest.  In 1999 it was revisd as the DIT-2.

I first studied these stages in the mid 80s during my psychiatry residency.   Later  in preparation for my Master of Divinity I would review this material.  I believe Gilligan`s work has not stood the test of time as well as Kohlberg`s.  Goldberg`s book Emotional Intelligence added to their understanding .I found them all to be useful and applicable to understanding clinical moral dilemnas my patients faced and helpful for my patients to see them as such.  

Doubt, the play

What incredible acting! What a brilliant play!.  I'd loved the movie so was actually looking forward to the play if only for comparison. I didn't really think I could like it better than the movie, given Meryl Streep's performance. Yet here I was tonight loving the play even better.
Doubt, a Parable, by John Patrick Shanley was performed at the Pacific Theatre at Hemlock and 12th Vancouver.  Ron Reed was the director.  Sister Aloysius was played by Erla Faye Forsyth.  She's such a fine character actor I found myself hating her and loving her almost at the same time. I missed the depth of thought and spirit that went into the writing in the movie. But as she, as principal, spoke to the beautiful and innoscent Sister James, played by Kailtlin Williams I was truly moved by the finely delivered phrasing of profound concepts of modernity and postmodernity.
Your heart must be warm but your wit cold if you are to achieve the balance you need to teach, to paraphrase, she warned Sister James. Kaitlin was pure delight when she spoke with all the enthusiam of heart felt youth inspiring and moving.  The expressions on her face as the conflicting emotions that played through her caught as she was between Sister Aloysious and Father Flynn was thing to behold.
Father Flynn, played by Giovanni Mocibob, was either falsely accused or rightly accused.  The damage either way was elucidated clearly in his humorous and sarcastic sermons and touching defence.  I found myself caught in his dilemna, one accused who might only have the sin of long fingernails but the very accusation was such to condemn and ruin his life.  Yet to protest invariably results in the further accusation , the lady protested too much. His truly touching and yet quite possibly demonic  defence of his actions raised questions about the very core of our society.
A plant on the stage was metaphor and the Principal listening to the radio stolen from a student obsessively tainted by the 'news' was a furthe clue. Yet the Kennedy era was just before the disclosures and there is so much doubt.  But the mother of the child, Mrs. Muller, played so realistically and feelingly by Leslie Lewis Sword spoke to the essence of suffering in the long history of black America.
As usual Pacific Theatre has again outdone itself with a truly inspiring and uplifting play that cuts to the core of culture and asks the most difficult questions.  Love and judgement, old testament and new.  The new age and new world order.  All of it entwined in a superbly crafted play, neatly directed and finely executed by the very best of performers.  Thank you. Ron Reed and Pacific Theatre for a night to remember!

Theft, Culture and Copyright

When we were in Ottawa we were told by locals that it was a 'safe' city.  We left purchases locked in our trunk and were told that was okay.  We were told by people who lived in Ottawa that it was safe to go out at night.  A poll was just released on "most liveable cities'. Apparently, Ottawa was #1, Vancouver #56.  Alot of different criteria goes into the poll not just safety from theft but that's implicit in the 'liveability' of a city.
Obviously if there are rules, the people need them. There's no commandment 'Thou Shalt Breath".  In the 10 Commandments the Jewish people are told by God according to Moses , Thou shalt not steal.' One imagines Moses had a problem with theiving Jews.  Given that laws have been enacted all over the world against theft it's not just a Jewish problem but a human problem.  Christians certainly kept that commandment in their Bibles. Yet in terms of priorities it was the Jews that first put it on their top 10 chart.  Other cultures don't have  "Thou Shalt Not Steal" in their top 10.
Stealing was the problem that Westerners encountered when they first came to North America.  The First Nations people were great theives. It was a major problem that brought on much of the war.  It might well be said that the White Man was 'stealing' when he moved onto the Red Man's land but the Red Man at that time had no concept of 'land ownership' on an individual basis. Their 'land ownership' was still tribal.  In feudal times in Europe the same thing occurred, the chief or lord of any territory owning all the land all the people being related to him.  Yet the problem of stealing that's repeatedly written about is the theft of tools and clothing and personal items.  Within the tribal society there was prohibition against taking the chief's headdress for instance but it was alright to steal a foreigner's knife. Property considerations existed around medicine man's tools but this 'tribal' condition didn't extend across the boundaries to outsiders.
It's possible to see the beginning of stealing behaviour in young children. A 5 year old and a 3 year old playing. The 5 year old takes the 3 year olds toy.  The 3 year old cries.  The 5 year old is triumphant. I can't say for sure without more extensive research than I'm able to do at this moment but I would believe this reaction a 'normal' reaction which I've seen cross cultural and believe indicates that at the time the 5 year old took the 3 year old's toy the 3 year old considered it her property. I watch my dog playing this game of 'theft'. He knows he's taking the cats toy from her.
So theiving to my mind is inherrently associated with a knowledge of a) somehow that the other person is hurt b) some element of feeling good and powerful c) a sense that a taboo has been broken in someway.  I believe that developmentally children and societies have a concept of property and possession.  Even if I'm 'renting' a motorcycle I'm not going to be happy if you take it from me. I'l be even less happy and show it if you even touch my Harley Davidson that I worked hard and long to be able to buy and own outright.
Bullies, dogs and children steal.
So why do Kings, Queens, Leaders of State, Religious Leaders,  Adults and others steal?
What stops them?
Well, the bully always says, "I steal because I can".  The powerful lead unrestricted lives.  Indeed the admonition among the powerful against stealing is principally "don't get caught".  Caught by who?  First the person who you are stealing from? Secondly any authority that might disapprove of stealing.
It's very easy for those who don't believe in God or an afterlife because they have less likelihood of getting caught eventually. Unfortunately for them they live lives of paranoia as a consequence because in their world view, quite likely, everyone is a potential thief.  Even in Christianity, the thief on the cross beside Jesus gets to go to heaven by simply believing in him. That's why the Italian Catholic Mafia families liked to have a priest handy in hope that a last moment confession would wipe out their lifelong history of theft and rape, murder and mayhem.  What silly superstitious men these were?
When as a kid I tried to steal my brothers stuff he was older and bigger and punched me.  Therefore if I wanted to take something of his I had to do it 'sneekily'.
In the pagan anaimalism religions the rules against theft aren't as clear as Judeo Christian  "Thou shalt not steal".  Instead they're fairly nebulous.  A person whose animal sign is a chipmunk or crow wouldn't be faulted for stealing bright shiny things. That's what chipmunks and crows do. It's in their nature.  Indeed the notion of change in many cultures and religions denies the capacity to learn or alter behaviour of members.  A person is born good or bad, a theif or not a theif. Fate versus free will dictates how much a person can change or learn.  Multi culturalism sounds nice on the surface but in the nitty gritty there's serious potential for problems.
In that case chipmunks and crows shouldn't be given jobs in banks.  Yet in our society in which there is a requirement for assimiliation to some degree we have rules against discrimination.  Yet we are quite happy to discriminate against a crow or chipmunk after they have stolen been caught, done time, and now have a criminal record that denies them work in any place where theiving would be a concern.
So theiving even if it is in one's nature is restrained by oneself in face of greater power. My dog is likely to steal from the cat but being a cockapoo won't steal from his great dane friend if the great dane holds a toy and growls.
But in Vancouver I can't leave anything in my car.  Thieves will and have broken in repeatedly and stolen things. The insurance folk are very loathe to replace the lost items, blame me for my stupidity, everyone knows Vancouver is a city of thieves, and hikes up my insurance premiums.
When I was in Costa Rica I was told the same about leaving things in my car.  Lonely Planet the travel guide often tells tourists in a variety of places that they should beware of leaving any wealth where it can be taken and even says that one should be ware of wearing jewelry.  In some places in the world people have had their fingers cut off by theieves in public places in snatch and grab moments all for the sake of the ring.
Many rich Americans I've heard are increasingly afraid to travel to lots of places in the world for fear of being kidnapped, kidnapping and selling the person back, being a profittable form of theft.
There are also people who think it's perfectly acceptable and culturally right to steal peoples hearts and kidneys. Naturally the person who was using their heart and kidneys at the time consider this a cultural affront.
In contrast there are poor places in the world where despite terrible poverty I've not felt I should fear for my life bcause I was carrying an expensive camera. I felt this way in parts of Bombay (now Mombai) I visitted. Yet in Mexico City I felt the theives were always watching me and my camera.
It's not surprising that 'cutting off hands' was once the treatment for theives.  Kleptomania is a disease category that's very difficult to treat. It's thought that the parents of kleptomaniacs denied their children love and now those adult children  are taking things to fill the gap.  Others argue  that their brain development isn't normal. The research around kleptomania could well be used as a template to understanding common theives, not loved as children, brain missing some part necessary for mature social behaviour as a start.
In one city in the United States everyone is required by law to own a gun. As a result of that this city has the least break and entry and theft in the country.  Theives are as opportunistic as my dog.  They're naughty animals rather than big lions.
There's a lot to do with the 'belief' systems which support 'entitlement'.  The idea that the rich are idle rich and came by their wealth as bullies and theives makes it right somehow for me to be a little theif. Philosopher Dr. Johnson, paraphased by Bob Dylan, said 'steal a little and they put you in jail, steal alot and they make you king'.  Being rich doesn't stop one from stealing either.  Rich men and women have often been caught stealing shiny items in shopping malls. Others walk away with things with an attitude of "I dare you to stop me."  A local former Member of Parliament is forever stealing locally by bullying special treatment and extra 'perks' claiming it their right.
All those who are filled with 'self pity' are potentially at risk for stealing from others because they believe others 'owe' them.
As Canadians who respect "multi-culturalism' I think we should make a concerted effort to investigate immigrant attitudes around thieving.  I know the rules are very clear with Christians who made the laws and constitutions of this society but I'm not sure if a person associated with some odd sect from another part of the world agrees with me that "Thou Shalt Not Steal" means "Thou Shalt Not Steal" from anyone not just members of your sect. This is the law that the Hell's Angels goes by.   As a tribe they feel it's okay to steal from me but not to steal from one another.  Robin Hood of old was all in favour of stealing from the sheriff but he wouldn't steal from Friar Tuck.  Communists like the present Chinese feel perfectly good about stealing from Capitalists like the present Americans.
Now the matter gets even more complicated because we're looking at the notion of 'intellectual property'.  If I write a book and spend 20 years doing it, or make a movie or compose a symphony, do you have the right to take that and distribute it on mass.  If your ideas about stealing weren't too clear about whether to steal your neighbours power tools to build your own house then it's not likely you are going to respect 'copywrite'.
So questions which need to be asked are 'under what conditions do you think its right to steal?
From whom is it okay to steal?
Should there be a death penalty for thieves?
Should all theives be offered the same treatments which have been beneficial for kleptomaniacs.  New medications following on the original success with SSRI's have been shown to reduce kleptomania.
Should the families and tribes of those who steal be punished , because some cultures haven't developed a sense of 'individualism' and the individual as such caught stealing is really nothing but an agent for the family or tribes
Should bankers like those at Goldman Sacks be allowed to keep their bonuses?  Or should all executives of the recent white collar crimes have their pictures posted everywhere so that we recognise them and avoid them. This was found to be an effective strategy dealing with pedophiles and might well work with theiving bankers.
In the end, Thou Shalt Not Steal was seen in studies of 'cultural evolution' as evidence of a higher cultural development because theft caused war and unhappiness. Cultures which were considered 'toilet trained' as such agreed with the golden rule, "Do unto others as you would have them do unto you".  "Treat others as you want to be treated".   That's why there are laws against theft.   My dog knows he shouldn't do it. It's in his nature and I've been able to stop him from taking the cat's things with training. It's not easy.  But it's certainly going to be necessary if we're going to have a society which encourages genius. Right now we have a society which encourages bullies.
We can't all live in Ottawa either.

Canadian Psychiatric Code of Ethics - II

http://ww1.cpa-apc.org:8080/publications/position_papers/cma.asp

Code of Ethics

I. Consider first the well-being of the patient.

II. Honour your profession and its traditions.

III. Recognize your limitations and the special skills of others in the prevention and treatment of disease.

IV. Protect the patient's secrets.

V. Teach and be taught.

VI. Remember that integrity and professional ability should be your only advertisement.

VII. Be responsible in setting a value on your services.

This is the full list of the Canadian Medical Association Code of Ethics. The CMA has written a short explanation related to each. Dr. Cliver Mellor prepared an 'annotated version" for the Canadian Psychiatric Association showing the relevance to psychiatry with some specific and general examples.
In my blog Canadian Psychiatric Code of Ethics part I I've address I. Consider first the well being of the patient and stated that I believe this should be the starting point for all 'codes of ethics' for all working in the health care field.
II "Honor your profession and it's traditions.  I have tremendous gratitude for the medical and psychiatric profession. I consider my training as a physician one of the greatest priviledges I could have in this life. I have further thoroughly thankful for the time I've spent as a physician and psychiatrists serving with patients in rural and urban communities.  The profession of medicine and psychiatry are to me truly grand and magnificent in their achievements and work.  The traditions of the profession are more complex. I will leave discussion of the 'traditions' of the professions to another time of writing.
III Recognise your limitations. This is to me obvious. I'm thankful that I work in a community of physicians and specialists and when I'm consulted I know that if I don't have an answer there is commonly a subspecialist who has more experience with a particular condition that I do.  I am a subspecialist and when I've been stymied by a case I've had the benefit of consulting colleagues in England, Australia and the United States personally as well as taking advantage of local resources including the College of Physicians and Surgeons excellent library and PuB Med literature search.  When faced with a difficult case I've had personal support from fellow psychiatrists who have helped me through difficult personal and practice issues. I have always felt a part of a greater and helpful collective even alone treating a patient in the wilderness as I've so often been called upon to do.
IV Protect the patient's secrets. I've considered this utterly important and gone to extreme lengths protecting files guarding against the 'loose lips that sink ships.'  Having worked in small towns, reservations and on islands with limitted population I've had to be extremely careful about patient confidentiality and information. Despite all this effort I made the error in hiring a staff person who despite being specifically educated and warned about confidentiality released patient information to a boyfriend and disclosed patient information to government organizations for her own personal profiit.  It didn't matter that I didn't recognise her sociopathic tendencies and did my very best to limit damage control by contacting police and notifying those people she had violated.  The experience did make me appreciate the Medical Office Assistants I had had who were collectively responsible and trustworthy in comparison.  I had personally approached two hospitals about their grossly inferior record keeping services and with the Dean of Medical Schools had both these hospitals security improved to minimum standard levels. In both hospitals I had walked in off the street and asked for senior colleagues personal files without showing credentials or having specific care responsibilities for the patient. I was not wearing a name tag, did not need to present identification, and was not known by the clerical staff.  I did not open the files but took the files to the senior personnel and explained the story and told them that I did not feel that I could ethically take the information that I was required to take from patients and have that information stored in this manner. The Winnipeg General Hospital Administrator wanted to phone the police. I am very thankful to the brilliant Dr. Arnold Naimark who essentially 'saved my ass' from the 'evil hospital administrator'  having been apprised of this situation, shocked by the shoddy service,  demanded that the standards be brought up to minimal levels ie requiring signing out and identification notification. It was an early in my career and despite 25 years of experience I continue to see the secular and non medical administration first response to notification of their inadequacy as 'kill the messenger'.  The clerical staff at a another major hospital required to "ID" everyone who took out files condemned me for making their work more difficult.
As a proto hacker I noted there were no 'firewalls' on early filing systems in provincial and federal government storage systems.  Recent cyber attacks by presumbly Chinese military indicate that no information is 'safe' in public filing systems .  There is a tendency to 'keep up the appearances' but there hasn't been any real attempt ot reasonably address the problem. I have at different times had thousands of dollars of cyber security for my office files but know that "a lock only keeps an honest man out'.
Given the difficulty of security ethically doctors are concerned about their 'notes' however legally and from insurance companies there's a trend to all information being made available to third parties and the 'space' in the traditional 'doctor patient' relationship has become increasingly narrow.
V: Teach and be taught.  That's been my way for decades and I have said that my patients are often my best teachers. An administrative doctor who was most peculiar thought that doctors shouldn't be 'taught' by their patients but their patients teacher. I didn't know what planet she came from but every clincian I know learns from each patient 's presentation and passes this learning on to how they deal with the next patient. The gap between clinical physicians  and beaurocratic physicians has never been wider and I fear that there is grave concern that increasingly a controlling managerial sort who wants to keep their hands clean will try to 'jump the queue' with devastating consequences for the profession. This has already been seen in RCMP a once great organization with tendency to promote from the ranks. Recently there has been increasing political appointments 'parachuted in' with the result that the 'administrators' may well not know how to find their arse with both hands in the service. (to quote one RCMP)
VI Remember integrity and your professional ability should be your only advertisement. This requires further discussion elsewhere as it really has been affected by what has been called the 'americanization" 'f the Canadian public health system. it's further affected by the ability of almost everyone to find out almost everything about anyone with the least effort in the cyber reality world.  What was once only available at high cost from a Private Investigator is available in a program from the local computer store as well as all the 'spy' ware tools from the local 'spy' store.  I'm rarely not being observed by some form of camera in the street or satellite coverage.  When is a 'celebrity doctor' 'advertising' or just hawking his or her wares.
VII Be responsible in setting value on your services. I believe this once had more to do with high prices being asked so that people couldn't afford medical or surgical services. Today 'for profit hospitals' and private 'fee for services' approaches come with 'whatever the market can bear' style capitalism.  In contrast I've been criticized repeatedly for 'giving it away for free' .  When I signed forms for my patients others hearing of it threatened their doctors to do the same.  As a result, not wanting patients threatening colleagues, I began to religiously follow the professions fee guides with regard to a number of things which I'd not really considered that importnat. I know my profession is wiser usually than me in terms of 'valuing service'. Even here "I blog" and give 'information' for free in a society where 'information' is bought and sold.  Many colleagues think that my doing 'pro bono' work is questionalbe and a judge recently criticized me for my belief that when I did 'pro bono' work it mad the work less subjct to negative motives and bias. He was right as those doing pro bono work might well be seeking 'status' rather than 'finances'.  I am continuing to learn about market factors and group process issues in the profession which senior colleagues often seemed to have learned long ago. Some of the senior medical administrators have over the years helped me immensely in understanding issues from a broader base than I'd originally seen them.  I have been very fortunate to have such colleagues.

Canadian Psychiatric Code of Ethics

The Canadian Psychiatric Association has a code of ethics:  It's well written and well considered. It's is the Canadian Medical Associations Code of Ethics Annotated for Psychiatrists.  The CMA Code of Ethics was 1996 while the Annotated code of ethics for Psychiatrists was completed in 2002.
http://www.ftsr.ulaval.ca/ethiques/CMApsy.pdf
It's a bit lengthy and unweildy so that like a lot of 'beurocratic documents' I can honestly say that the majority of my colleagues would be hard pressed to recite a significant number of it's provisions.  The Canadian Medical Associations Code of Ethics is similiarly beurocratic, lengthy and unweildy such that a majority of physicians is unlikely to be able to cite a significant number of it's provisions.
That said, these same physicians and psychiatrist could tell you in detail and at length the diseases that affect the nervous system or list extensively what one must do procedurally in the proper work up of a desperately ill patient.  Further, the vast majority of physicians and especially psychiatrists act in a most ethical fashion as generally understood by their profession and the community at large. Indeed, relative to most sectors of the community at large physicians and especially psychiatrists are highly ethical individuals with years of experience and training and in depth consideration of relationships with other humans, those humans commonly being vulnerable, sick, sometimes psychotic, often in pain and clearly not on their best behaviour.
In reviewing though all these 'ethics' that are recommended I see that they are quite impossible to follow in some instances. This is something I will consider in due course.

My first consideration with regard to Codes of Ethics was the 'conflict' that ethics of physicians might have with  'ethics of administrators'. When I sought to find a Canadian Hospital Administrators Code of Ethics, I couldn't find one.  My personal experience has been that the ethical decisions that I have had to make often routinely have put me in direct conflict with hospital administrators who do not for instance share direct responsibility and accountability for an individual patient.  Indeed I have heard hospital administrators refer to me, not as a psychiatrist or as a physician but merely as a 'health care worker'.  The history of referring to someone as a 'worker' was common in the early years of communism and early union movements.  I'm not sure what 'code of ethics' the 'workers' of that era had and don't know of any 'code of ethics' for 'heath care workers'.

There further is as yet no agreed code for 'health care professionals', another term administrators have liked to call me, which obfuscates my own identity as a physician and a psychiatrist and the ethical obligations I have as a physician and a psychiatrist.

There was a conflict noted in England a decade or more ago which lead to considerable reorganization of hospital and community decision making to 'limit liability' of physicians. In Canada when 'health care professionals' gather the 'accountability' of the physician is directly associated with 'liability' and the liability of the physician historically was greatest.  Recently in the US law suits commonly cite the hospital and physician and increasingly the nurses but do not specify the CEO.

Increase in the accountability of administration relative to patient care is clearly an admirable dimension of ethical care.

To the best of my knowledge such reform of "individual and collective 'liability" and hence 'accountability' has not occured in Canada though it's been several years since I've actively involved myself in Canadian hospital and community care systems. I completed 2 years of the public health community medicine fellowship a couple of decades back. That training along with my community psychiatry training indeed sensitized me to the increasing chaos, ethical dilemnas and loss of autonomy of the physician relative to institutional perogatives. I personally experienced considerable bullying and abuse in the system so like large number of physicians retreated into my practice.  Increasing numbers of others are avoiding clinical care altogether, it being vogue indeed for people to get and md followed by an mba or llb (law degree) than actually specialized in clinical medicine or psychiatry.

In general a 'code of ethics' is limitted by the prevailing authorities.  A professional is only as professional as his or her autonomy.

The prime directive of the Canadian Medical Association Code of Ethics is
1) Consider first the well being of the patient

What happens if this comes  secondary to the 'profit' motive of the organization or 'the availability of  resources' .

It's a bit of a platitude like saying "the customer is always right'.

Today's newspaper and radio health care 'crisis' is that of a pharmaceutical company not making sufficient 'supply' of a life saving medicine and not warning Canadian pharmacies or governments that they were running short.  I was amused by this in a 'black humor' sense only because it reminded me of my work in northern Canada when the stock of 'penicillin' was depleted. I rasied hell and got the necessary penicillin flown into the community to save the life of a child with pneumonia or meningitis at the time.
I would today be called a 'disruptive physician' and severely reprimanded. The message to all physicians to day is not to rock the boat.

I have been in two hospitals now where the 'oxygen' tanks were not filled with 'oxygen'.  I know of two deaths directly related to this.  I recently learned that health care employees, including physicians were going to be required to sign 'non disclosure' agreements to have jobs. I wondered at the time if a physician could 'ethically' sign such an agreement.

On dozens of occasions I have followed the prime directive to 'consider first the well being of the patient at extreme personal cost to myself in terms of health and loss of wealth.  I know many physicians who have shared this experience in the present health care systems.  It is very hard indeed to 'consider first the well being of the patient' when there are those around who have entirely different agendas.

Recently a patient was found dead 24 hours in a Canadian hospital waiting room and to date I've not heard even who was ultimately held accountable.  I loathe the CBC going on and on about robocalls in the elections or about a defence minister chartering a plane to go home for a weekend when who is accountable for a person dying in a waiting room in a Canadian hospital goes without a Royal enquiry.

It's one of the greatest national scandals of the Canadian Health Care system and yet it's a subject that was covered in the popular media mostly as an isolated tragedy. I saw it as evidence of the epidemic proportion of administrative breakdown in the health care system. To the best of my knowledge it never warranted a letter to all physicians, hospitals, or hospital personnel about how we shant have that sort of thing happening again. My impression is that that sort of thing gets 'covered up' and shunted aside as an 'embarrassment'.  When things like this happen I want a "pathologists report' on the cause of death and the organs infected and decaying.  I really would like a department of 'systemic pathology' that gave 'weekly rounds' on the institution in question or the health care system as a whole.

There was  no mention that the hospital administrator was sacked either but they are forever going on about accountability. Accountability for physicians means loss of license and loss of position and loss of income and a whole dirge of liabilities.  I don't seen any evidence of a 'level playing' field in comparison when a patient lies dead in a hospital waiting room for 24 hours.

I don't know if the patient was 'admitted' and whether they were under a doctors name and if that doctor even knew they had a patient in the emergency. Mty emergency doctor colleagues have reported that increasingly they are last to know that sick patients have been assigned to their care and that more significantly they rarely today have the resources or staff to adequately 'consider first the well being of the patient'.  How can a physician 'consider first the well being of the patient' if he doesn't even know that patients have been assigned to him until there is a crisis.

What is a physician to do when the very system they work in is 'unethical'?

Bonhoffer, the remarkable priest who served during the Nazi reign and was martyred for his ethical and moral stance is one of the greatest tales of the 20th century. Bonhoffer's central dilemna was that he was ethical, his church wasn't , and the nazi's weren't.  He was Lutheran.   Ethics can't be considered in a vacuum.  The Catholc Pope and indeed most of the major church members of the day failed to function in an ethical or moral manner in face of the overwhelming systemic flaws.

Physicians who 'protest' are today called 'disruptive physicians'.   Ethically  'considering first the well being of the patient' in a hospital system or a community health care system they may well be  martyred.  Rocking the boat is professional suicide.  There are 'cultures' which surround institutions. This was the topic for psychiatrists of the book "Asylums, a study of totalitarian institutions".  The "company doctor's has historical been a term of derision to refer to a doctor whose 'ethics' are subsumed by his allegiance to the paycheque or paymaster.

Doctors of 'conscience' have increasingly taken to writing their names on lists.  The Bahrain Doctors are presently being tortured and imprisoned for being ethical doctors and following the general code of ethics most doctors subscribe too around the world. The partisan government of that state however decided that doctors could only treat police and not civilian protestors.  Doctors who treated protestors were subsequently raped, abused and faced all manner of persecution.

The most famous and historic medical code of ethics was found in the Hippocratic Oath.

http://en.wikipedia.org/wiki/Hippocratic_Oath

Original

Greek Wikisource has original text related to this article: Ἱπποκράτειος ὅρκος

Original, translated into English:^[4]

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause anabortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists inthis art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I willkeep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.

The modern version is a weak sister that doesn't even emphasize the is to 'do no harm'.  It strikes me too that the original Hippocratic oath contained greater wisdom and came from more extensive clinical experience and knowledge of humankind. The modern version is still pretty impressive and very clear as it uses the word 'covenant' indicating a 'covenanted relationship' between doctor and patient.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

[edit]

Later I'd become a dues paying member of the Hippocratic Society in Canada because this group felt that the hippocratic oath was being violated by the demands of the Canadian government. As such I become politically incorrect and open to persecution for my ethical stance at variance with the position in Canada at the time in physicians increasingly being expected to 'do harm' in such areas as 'abortion" and 'euthanasia' or 'assisted suicide'. Having been a member of Canadian Civil Liberties Association and the Human Rights Association and Physicians for Social Responsibility I was concerned that physicians were being denied 'choice' in the procedures they personally agreed to do where there were alternative resources.

As a member of the Christian Medical and Dental Society I was discussing ethics and morality in a way which had simply never been a part of the discussion of the provincial bodies or federal bodies of the medical societies whose conferences I'd previously attended. The discussion of ethics was further a central topic of the small group discussions that were apart of the International Doctors in AA, especially the psychiatrist groups and the cyberdocs on line discussion. Here often doctors would share the dilemnas they faced and find support rather than judgement and exclusion as I'd noted in other areas of medicine.  Punishment was common in medicine whereas support was limitted. Judgementalness and hypocricy were common whereas 'collegiality' was declining annually in the 'new world order' of the health care worker paradigm.  I wrote national articles relating to this but these served more often to define me as a humorist and maverick than one deeply concerned for the future of health care in Canada.

It creates a major ethical dilemna for physicians working on health care teams when the doctor sees the relationship with patient as covenanted and the other players see the relationship differently.  As an example a former doctor, at the time functioning as an administrator, made the crude statement to me about medical practice, "it's just a job, Dr. Hay".  Ever since I heard that I've been waiting for millions of dollars back pay and all the benefits I didn't receive for the 'health care job' I never signed up for.  All that while I was being a physician and psychiatrist I apparently according to this administrator was just a worker doing a job. 

As a doctor I took a Hippocratic Oath in medical school.  I've had jobs and never been required to take an "oath" to do them.  I stood with a hundred classmates, as well as the dean and teachers at the University of Manitoba Medical School. Together we recited the code of ethics that I would practice medicine by thereafter. This was not to my knowlege the CMA code of ethics but the simplified  modern version of Hippocratic Oath. I have had to struggle repeatedly with the conflict that occurs with 'loyalty to the group' versus 'loyalty to the patient'.  I have further had a great deal of difficulty as a Christian and my Christian priority is to tell the truth, the whole truth, and nothing but the truth, so help me God, something I swear on the Bible.  In contrast I 've worked in a darwinian relativistic social setting where people routinely talk about 'my truth' and 'your truth' "whatever truth covers your ass' in beurocratic terms.

I did not study the CMA Code of Ethics as part of my medical school training or as a psychiatric resident. I was given a pamphlet and advised to read it.  I did that and only later did I take an interest in the code as an object of serious study.  The first time was when a superior demanded I do something that was unethical and I refused to do so.
A colleague replaced me who was more compliant and less ethically 'squeamish'.
I made a long lasting enemy of the superior who became wealthy and powerful through what by the Canadian Medical Code of Ethics was unethical behaviour.  People can witness that life is 'unjust' and often 'bad people' do succeed.  Whole religions and philosophical and cultural systems have been developed to address such problems.

By the time I became really interested in the code of ethics I had extensive clinical experience and knowledge and saw that the code was likely outdated at the time it was written. This was a result of the rapid change in the medical care delivery systems and changing relationships federally, provincially and most significantly, the means by which care in Canada was funded, the change in the 'health care team' and the change in status of the 'team player's and indeed the change in the "name of the game: and the game itself". The  different levels of care allocated by 'status' or 'weath' in Canada especially in British Columbia where I practiced psychiatry in a different light reflect the same ethical error the Bahrain doctors failed at.  If we are only 'health care workers" then clearly he who pays the piper calls the tune.

There is now and  increasing disparity of available care, even at the simple level of rural and urban but most importantly culturally.

In fact I reflected on the Hippocratic Oath which I had sworn too and how difficult it was for me to fulfill that oath dealing with beaurocrats and other contenders in the present system.

When I worked in a country hospital I left after a year when the monies for a baby incubator appeared to have been diverted for the remodelling of the administrator's office.  Administrators in general have had an inordinate interest in 'perks' .
As a result of my formal complaint to the board and meetings with the mayor and councill this administrator was eventually removed.  I would estimate that my time voluntarily spent in this endeavour was hundreds of hours. I wrote several lengthy papers and met with many individuals. I actually wasn't particularly interested in the individual but couldn't forget delivering a premie in the back of an ambulance at high speed in the middle of a blizzard.  We were travelling at high speed to the nearest hospital with an incubator and the volunteer assistant ambulance driver, a grizzly old farmer, held the baby close to his bare chest while I dealt with the mother's post partum hemorrhage.  Mother and baby did well as a result of the heroics.  Standard care would have certainly met death of the baby.

Indeed 2 years later when I was working with the university I was asked by mayor and town councill to return and address the issue so they could relieve the administrators whose behaviour had cost more life and suffering in the community and staff losess.  The consequence was that the hospital administrator was removed.

As in any of the disputes there were many angles, sides and politics and players.  In his mind he doing a 'good job'.

What most interested me though was learning that the same person had been removed from their previous appointment for simliar questionable behaviour.  Indeed a leading hospital administrator in the system was kind enough to take me aside and share that this person had once worked in her department and his behaviour could best be described as sociopathic.  Misallocation of funds was the least of his noxious behaviours.

She had had him removed and found that he was only transfered then and now she had become aware of his recent position because of the news and scandal  that surrounded his final removal.   He was indeed as tricky dicky as Nixon in his dealings and the board was mis informed of all manner of things going on in the hospital.  They were enlightened eventually and made what I personally considered the right ethical decision. Health care in the community and  hospital according to the doctors and nurses who remained improved dramatically.
I had effectively to my own way of thinking nipped "hitler' in the bud.  This devious and dubious person was caught with their hand in the cookie jar and matters rectified.  I could not practice medicine as I'd been trained and cover my back at this time. My colleagues were afraid of this person and felt bullied and terrorized.
I sacrificed my career though being an ethical physician.  I had hoped to stay at that hospital many years at least. I enjoyed the community and the staff and colleagues but I didn't abide by the administrators direct interference in medical care.  His behaviour was dangerous and unruly. The existing systems for addressing out of control administrators were wholly inadequate and cumbersome.
I admired most my colleague who was as concerned as I about the baby incubator but had given up hope on the ethics of hospital administrators or the ability to work with them. His solution which I so admired was to approach Kiwanis and ask them for help.  They raised the money for a baby incubator.  To this day my colleague is working within the system on behalf of his patients.  I know that he goes above and beyond the call of duty to be an ethical physician and that he is mostly an 'unsung hero'.

I personally was considered a 'loose cannon' in beaurocratic circles,  The peter principle prevails in peace time beurocratic systems and  anyone who rocks the boat is considered a threat.

The dilemna that faces the physician to day who attempts to 'consider first the well being of the patient' or try to live by the Hippocratic Oath is much the same problem an individual considering marriage might face if they thought marriage meant a monogamous institution and their partner felt marriage was a polygammous institution.

When these codes were written the doctor was the dominant person in the heath care field.  The health care system of Canada is considered by many to be a dirty product of the deplorable days of Canadian paternalism.  Indeed hospital administrators when I began were commonly former doctors or despite the sexist and erroneous descriptions of that era, nurse administrators.   Most of the administrators had medical family if they themselves hadn't started out in medicine or allied health care fields like nursing.  (The Minister of Health of Canada was even at one time a Psychiatrist and commonly had medical affiliation before the new administrative model which said a Minister of Health didn't need diddly squat health care training and the Minister of Agriculture anything need to know about farming either.  The fallacy of this argument is that to date the Attorney General remains a lawyer. Politically, administratively I don't believe in feudal lordship but agree with the antequated and much aggrieved notion that ships captains shouldn't be literary critics alone)

That has all changed.  The doctor is mostly an employee in the hospital today.  The Canadian Code of Ethics for physicians is commonly interpreted within the provincial framework of the medical association. Health care is primarily a provincial responsibility in Canada and increasingly division in Canada has resulted in diversity across the country.  Doctors working in one part of the country have different political expectations from doctors working in another part of the country. Privatization has thrown a whole other hoop into the game.

While collectively doctors have been demanding a 'national license' and 'national standard' for medicine and psychiatric licensing the existing beaurocracies have resisted all reform and impeded any effort to expedite standardization at these highest levels. Administrations have grown like a cancer with layers and layers of redundancy.

 The consequence is that a Canadian doctor today may well be at variance with provincial pay masters relative to ethics. In addtion provinces have developed a whole other level of beurocracis in 'authorities' and these confuse the matter more. Additionally the 'professional bodies' legislations have attempted to group disparate care givers from physicians to hospital janitors into an all encompassing "health care" "professional" bodies.

This destruction of relationships between individual professionals and their traditions is likened to the failed attempt to put the army,navy and airforce under one Canadian uniform and command without respect for inherrent differences. There are individuals and groups and ethically there is a need to respect these differences.
As a result of war the 'administrated' destruction of Army, Navy and Air Force in Canada was chucked despite milllions of lost dollars in administrative costs and Canada again has three separate divisions of military working together as they always have under a supreme commander.  (One almost wonders if the idiot administrators who created that costly fiasco didn't refuse to admit their stupidity and shuffle their bad ideas over to health care in a vain attemp to save face!_

When a physician with a code of ethics looks beside him at fellow team players, having already noted that the hospital administrators themselves may not have a code of ethcis,
the Canadian Nurses "code of ethics' present as a very different kettle of fish from  the Canadian Physicians Code of Ethics.
First It does not have the 'prime directive' of "Consider first the well being of the patient." that is the hall mark of the CMA Code of EThics. There is further no 'covenanted' relationship in modern nursing as their was in the long history of nursing, especially represented in the ideals of Florence Nightingale and all the other bed side clinician nurses.  The nursing code of ethics reads more like an academic beaurocratic document than something as glorious as the nursing tradition.
It drily begins instead: by listing 7 values:

1. Providing safe, compassionate, competent and ethical care 2. Promoting health and well-being 3. Promoting and respecting informed decision-making 4. Preserving dignity

5. Maintaining privacy and confidentiality 6. Promoting justice 7. Being accountable

Ethical nursing practice involves endeavouring to address broad aspects of social justice that are associated with health and well-being. Part II, “Ethical Endeavours,” describes endeavours that nurses can under- take to address social inequities.

It's noted first that there is no 'prime directive" to 'Consider first the well being of the patient" in the nursing code of ethics.  Also there is no simple statement such as 'do no harm' but instead a considerable emphasis on 'social inequitieys and 'justice' . Historically these latter have been 'legalisms' . (Imitation is the sincerest form of flattery).

The word 'ethical' is inherrent in the 'code of ethics' which is at least redundant and concerning given what I've written elsewhere about the circularity of definitions surounding terms such as ethics and morality in an 'age of narcissims' and a 'multi-cultural' aculturalism.  When one respects differences one doesn't deny them.
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When I did a search for Canadian Pharmacists Code of Ethics I didn't find such a body but did find a Newfoundland and Labrador 2001 Pharmacists code of ethics.  It did not either have as a prime directive "Consider first the well being of the patient" and it didn't state clearly state as the original hippocratic oath did, 'do no harm'.

Given that the buzz word in medicine these days is 'team" approach and to hear the politiicans health care is about the patient there seems to be variance on first sight with the positions of the Codes of Ethics of the various 'team players. I haven't considered the "professional" body of hospital janitors or looked at their code of ethics but I would hazard the guess that the prime directive is not 'First consider the well being of the patient".

What I noticed in my practice was that different 'players' on the team called the 'patient' different things too. Most recently 'client' and 'consumer' have been popular words among the beuorcrats as recently parallelling these new motifs, patients have come forward in increasing numbers  calling themselves 'victims' and 'survivors'.

I personally believe that Hospital Administrators need a Code of Ethics if they don't already have one.  I would further suggest that all groups share the 'naming' of the thing they are discussing in their various 'codes of ethics' .  I have been treating patients as patients , a covenanted relationship, whereas I commonly am discussing a patient with an administrator who has been referring to them as consumers and sometimes even suggesting they are commodities.  Worst of all I have seen patients described as "units'.
That said I do think that if there is to be a 'professional body' that includes such disparate organizations as the navy, army and air force with all their various traditions and beliefs and responsibilties there needs to be a common 'code of ethic' for the 'team'
My vote, aging as I am, would be that we all agree:

1. Consider First the well being of the patient.
2. Do no harm

I personally find the nursing ethereal  code of ethics academic gobbly gook like the the ramblings of the pharmacists code of ethics made for lawyers,  sociologists and beaurocrats in general but not really relevant at the bed side where the rubber hits the road.
I have always considered first the prime directive 'Consider First the Well Being of the Patient" at the bedside and secondly I have known well that I must do my best to 'do no harm'.  It's a bit like the ABC's of life saving.  It's coloured my practice through every aspect of care and been a horrible  rock about my neck. Without adherence to these 2 ethical rules I could have been a millionaire many times over and long ago retired from the practice of medicine.

Ironically when the administrators are not meedling like enfant terribles the heath care teams function amazingly well because of the inherrent goodness of the people who enter care giving professions.  Given the disparity and differences in the end it's almost miraculous the good that gets done.  I don't think most of the grass roots folk consider the 'ethics' codes but rather "do the next right thing' and if they have clinical experience tend to be on the same page as those around them.

The same was found true in the military and the restoration of the separate traditions and respect for the independent and individual nature of the different warriors was again found necessary when Canada was at war.

I personally hope that this disgusting era of the Canadian 'health care worker' comes to an end and I can get back to what I was trained to be, a physician, and psychiatrist, ruled by the ethics (and traditions) of my profession.  I see that the Bahrain doctors are facing a kind of administration mindset that governs commodities, consumers and clients.  I don't see physicians being tortured for treating NDP patients in Canada this year but the detour that has taken place in these crazy years of increasing 'physican' and 'psychiatrist' as 'government health care worker' and 'unit' or commodity is likely to give rise to increasing ethical dilemnas the further along the road we go.

Professionalism requires that a body be independent and autonomous.  That is to say that I enter a relationship with the employer as a 'contractor' but may have all the benefits that were defined in the salaried relationship.  There is no longer a respect for the physician and psychiatrist as a professional and autonomous. Further there is coopting at all levels which create increasing ethical dilemnas especially if a physician holds to the prime directive 'Consider First the Well Being of the Patient.

I would argue that economists and ecologists even, and especially ethicists entering in to the health care field, be required to take an oath, indeed all working with patients, take the oath to 'do no harm' and to Consider First the Well being of the Patient.

My belief is that the Minister of Health as an elected representative indeed has already made such a committment to get into office in a democratic society.  But are those who are 'appointed' on the same ethical level.

How indeed can any team work if some are playing hockey whiles others are on the ice playing with golf clubs in silly golf suits. That's a touch of a  beginning for the discussion of the chaos in todays hospitals and community health care centres.

- late night ramblings after being woken again by a nightmare about trying to save a life