Dear Editor,

The fact that a licensed physician, Dr. Conrad Murray, was prosecuted, convicted and sentenced for medical malpractice is not all that unusual. Some medical responsibilities have been made into laws and violations of these laws are prosecuted. More than unusual however was the public chastisement which Dr. Murray received from the judge not for his illegal acts but for his strictly ethical lapses. After issuing the sentence the judge began to lecture indeed to excoriate the doctor for violating professional medical ethics. A humiliated Dr. Murray turned his back and could not stand to look at the judge. After sentencing him for malpractice, Judge Pastor bashed Dr. Murray for failure to live up to his own medical ethical code. This was unusual and it provides an important insight into the relationship of professional persons to society.There are three classical professions; medicine, law, ministry. The word profession comes for the Latin verb profiteor, profiteri, professus. It means to make a public statement or promise to do what is best for others rather than to serve one's own selfish interests. Each profession has its own set of ethical standards (a professional ethical code). In response to the public promise to serve the needs of others, professionals are given unusual autonomy, broad public respect and many public privileges. What made Judge Pastor's lecturing and preaching to Dr. Murray unusual was that it was a member of the law profession scolding a member of the medical profession for violations not of law but of ethical standards of his own medical profession.Before making a public commitment to serve the needs of others, the professional person has to complete difficult educational requirements and demanding technical training. Validation of these accomplishments comes from institutionalized tests. Associations of professionals (American Medical Association, American Bar Association) develop the tests, set the ethical standards and monitor the conduct of fellow professionals. Professional associations oversee the profession and the conduct of its members. Each profession enjoys an independence and the conduct of professionals is monitored by fellow professionals with designated responsibilities for maintaining conformity to professional ethical standards. Law professionals do not usually lecture medical professionals about professional ethics.Professional persons belong to communities and officers of the professional associations judge the conduct of members and sometimes impose sanctions. Fellow professionals must report ethical violations to professional association authorities. What one rarely if ever sees is a member of one profession (Judge Pastor) chastising a member of another profession (Dr. Murray) for violation of his own professional ethical standards. It is rare but justified because violations of professional ethical standards offend broad segments of a population. Judge Pastor was lecturing, preaching and criticizing Dr. Murray for the many Americans who were also offended by his immoralities.Dr. Murray was definitely not keeping the public promise he made to serve the benefit of his patients rather than his own interest. He definitely was publically in violation of professional medical ethics and Judge Pastor was expressing the outrage of a broad segment of the American population. Professionals receive public respect and public privileges and when the core professional ethics is violated, there is righteous anger and a sense of public betrayal.Medicine like law and ministry is always influenced by the surrounding culture. That cultural influence sometimes can reach the point of subversion. What is the surrounding contemporary culture which first threatened and then subverted Dr. Murray's professional ethics? It is the culture of capitalism, the culture of money? Dr. Murray charged $150,000 a month for doing what the patient wanted even when the patient's requests were expressions of his illness and therefore harmful to himself. In many different ways Dr. Murray was doing what was harmful rather than what was helpful or beneficial for his patient and the motivation was money for himself. Dr. Murray's behavior went beyond illegal and violated the core ethical standard of his own profession: to establish a personal doctor-patient relationship and then to do only what is helpful or beneficial for the patient. Instead, he used the patient as an object for generating money for himself.Judge Pastor had a right to be angry. Medical professional violations affect a broad segment of society and cause extensive outrage. The same was true of the ethical violations of priests/ministers and bishops. There is a lesson for all professionals in Judge Pastor's outrage. If the U.S. does not survive as a world power, historians will certainly identify the widespread moral failures of professionals as a preview or signal of cultural collapse.James F. DraneRussell B. Roth Professor of BioethicsEdinboro University of PA