Michael Jackson and Medical Paternalism

Since Michael Jackson’s death, there has been a push to use the long arm of the law to ransack pharmacy shelves and pluck out a killer. Law enforcement and the public seem thirsty for the arrest of one or more of Jackson’s doctors on charges of homicide, or more specifically manslaughter. A physician can be legally responsible if he is found negligent or reckless in the death of a patient.

Dr. Conrad Murray was present during Jackson’s last moments, and if he physically administered a lethal drug, it would, of course, place him directly in the firing line. But what about the dozens of physicians who have written prescriptions for the singer over the years and who are now being tracked down and investigated? The indirect act of prescribing medications can legally expose an MD, but should it? Should the law be changed to shift a greater degree of responsibility to the patient?

Medical paternalism is interference in a person’s health by a doctor, the FDA or another “authority” because the “authority” is assumed to know what is best for that person. It is imposed against a patient’s will, results in a limitation of autonomy and can spiral into a “you can’t handle the truth” philosophy in which pertinent information is withheld from the sick.

Michael Jackson used aliases and “doctor shopped,” which means he went from one physician to another until he acquired the medications he desired or needed; and a tremendous amount of evidence suggests he required drugs to function. Debilitating insomnia had plagued him for years, just as it did Elvis Presley and Heath Ledger, both of whom also died from prescription drug overdoses.

Michael Jackson’s nurse, Cherilyn Lee, says the singer begged for a powerful sedative, even though he knew it could be deadly, because he was desperate to sleep; and publicist Rob Goldstein says Jackson would dance for eight hours straight in his hotel room hoping it would make him tired. Two months prior to his death, Heath Ledger revealed his agony in getting only two hours of sleep per night; and Elvis Presley’s doctor, George Nichopoulos--whose medical license was suspended when the singer died—says Presley got no more than three hours of sleep at a time. Presley was caught in demanding cycle of needing energy at showtime, then seeking sleep so he could feel refreshed the next day. Perhaps medication was the only solution if he wanted to remain an international star rather than an infirm recluse. Jackson had just left a more secluded life to jump into a grueling rehearsal and concert schedule when he overdosed.

It is all too easy for those who are free from pain and from crippling insomnia to mount their moral high horse and preach about willpower and alternative remedies. Most insomniacs have tried everything, still suffer and turn to heavier and heavier medications. Check the Internet blogs and sleep disorder forums; talk of suicide is as routine as brushing ones teeth.

“I’ve had insomnia for 14 years,” one person writes. “What is the value in a life with chronic unrelenting insomnia night after night?” Someone replies, “I am at 13 years, contemplating suicide.”

A lawyer comments, “If I get off meds, I can’t do my job,” and a teacher says, “I’m literally fighting to stay awake as soon as the day begins. I feel like death. I am only 25, and I look like I am 35-40.”

An unemployed woman writes, “My $200 per hour doctor is no help. He won’t prescribe sleeping pills because he is worried I will deliberately overdose. But life is not worth living. All I do is cry.”

Is this how Michael Jackson, Heath Ledger and Elvis Presley felt? If so, one can understand their desire to try hardcore medications, even at the risk of addiction, injury or death. Plus, life in show biz is demanding: a person must be at his best regularly and at exact times, a Herculean feat for someone with chronic insomnia.

Michael Jackson’s doctors have been described as greedy, selfish enablers with “blood on their hands,” but isn’t it just as likely they are caring individuals who are willing to risk personal liability to help the suffering? Dr. William Hurwitz has been described as such a person. He was a Virginia pain management physician, but now sits in jail for prescribing drugs that some of his patients abused. His property was seized by authorities, and after his practice closed, two patients reportedly killed themselves because of untreated pain.

Mentalist Uri Geller and one of Michael Jackson’s bodyguards claim they confiscated anesthesia injection equipment from the singer and screamed at him to get off drugs, but he ignored their warnings. Jackson was clearly willing to assume the risk, so why can’t his fans and family respect his decision? He would certainly want to be held personally responsible for his health-related choices rather than witness what could be described as a modern-day witch hunt against physicians who were arguably just trying to help.

Personal responsibility is unfortunately out-of-style. Today’s society is like a game of dodge ball: there is a tendency to skirt responsibility, shoving a scapegoat out in front to be struck and blaming the team’s loss on him. History teaches us that sins are symbolically washed away when a scapegoat is punished; it’s a ritual that seems to provide psychological satisfaction for a mourning nation that needs an answer to failure and loss. I believe this explains why doctors are routinely and overzealously pursued when a celebrity dies of a prescription overdose and why there is public outrage towards the doctors in Michael Jackson’s life.

Perhaps my libertarian tan lines are showing, but I think doctors, the FDA and other “authorities” should be advisors rather than powerful patriarchs who can shove their mighty pen in their pocket, depriving patients of medications which may be their only hope for a pain-free life. Centralized prescription databases—which are being launched throughout the nation--are risky, “big brother” enterprises that should be discontinued until such time as patients are given greater control over their own health.

In general, people assume a passive role in their medical lives, mindlessly trusting doctors. Instead they should be legally entitled to take greater responsibility for their own wellbeing and encouraged to research the pros and cons of their medications, in addition to pondering—rather than robotically accepting--the advice offered by health professionals. It is simple to log onto Internet forums and read about drug side effects and benefits, as well as clinical studies.

To assure patients are properly advised of side effects, signed disclosures could be required along with impartially produced Internet videos outlining the disadvantages and advantages of a particular drug. The goal would be threefold: proper disclosure, input from a doctor and tools that help individuals make decisions that are right for them.

Regulating medicine through criminal law enforcement is misguided and counterproductive, and could lead to fewer physicians, especially in the chronic pain management field. According to the Association of American Medical Colleges, there is already likely to be a shortage of 124,400 doctors by 2025. There are medical professionals today who specialize in “self-defense,” by putting their own desire to stay out of criminal court above the interest of the patient. Some flat-out refuse to treat those with chronic pain due to the ever-present oppression and intimidation by law enforcement. The Hippocratic Oath should not be at war with the Drug Enforcement Administration.

Individualism and self-determination are fundamental values that most of us cherish; however, in medicine, they rest on the pharmacy’s dusty back shelf. Medical paternalism is outdated and not a panacea.

America needs a new prescription; and frankly, I think Michael Jackson would agree.