Tiger Beatdown

Many medical students swear some version of the Hippocratic Oath when they become doctors; the oath has become the thing laypeople associate most with medical ethics, even though not all doctors swear by it, and it is more symbolic than binding. It’s a reminder, though, of the ethical training taken in school and the legal responsibilities doctors do have to their patients in terms of ethics. Of particular importance is the need to provide patients with accurate, timely, and comprehensive medical information so they can make informed decisions about their treatment or the decision to stop treatment.

Keeping information from patients is not in keeping with medical ethics. It makes the power dynamic between doctor and patient even more unequal, and breeds mistrust. Patients, after all, are routinely reminded that they should tell their doctors everything, even if something doesn’t seem relevant or obviously applicable, because you never know when something might pertain to diagnostic and treatment decisions. Those who hide things from their doctors because of fear, shame, or other complex emotions are chastised for it, and if there are problems with their treatment, it’s blamed on the patient. If only you’d told the doctors about the pain in your stomach before, they could have caught the cancer.

Patients have a right to expect the same thing from their doctors, to be given information about themselves. Patients should be able to read their own medical records, review test results, and have information explained to them in a manner that is accessible. They should be able to ask questions about treatment options and retain copies of information for future use. Retaining this information may be important in the future; what happens if a patient moves away or travels and gets sick and the original records can’t be located? If the patient has a copy of them or has been educated about their contents, this information could become critically important to a new treating physician.

That’s what makes gag orders on physicians especially chilling. It’s not just the fact that they’re repulsive on the face of it, they’re also incredibly dangerous. And in Pennsylvania, that’s exactly what doctors are dealing with right now in the form of a new law that allows them access to proprietary formulas for chemicals used in fracking, but only if they agree not to disclose the contents to their patients.  Doctors have fought long and hard for this information on the grounds that it’s critically important for patient treatment; it’s rather difficult to provide appropriate care to someone exposed to unknown toxins. If information about toxins is available, it should be provided to the treating physician so the patient can get the best possible treatment in a timely fashion.

But Pennsylvania doctors aren’t allowed to tell their patients what they were exposed to. People injured by fracking are not allowed to know what is inside their own bodies, what they may have ingested that made them sick, and may continue to make them sick in the future. If they develop cancer in 30 years as a result of fracking, they can’t tell their physicians which chemicals they were exposed to in 2012, because they won’t know. It’s a lot harder to tell if a patient is sick from fracking if a doctor can’t even access basic information about chemical exposure.

The last few years have marked a rising level of government intervention in medical practice, especially when it comes to autonomy and allowing patients to make decisions about their own bodies. The right wants to compel women to carry pregnancies to term even when those pregnancies are unwanted or endangering. Legislators apparently think patients don’t have the right to know what they were poisoned with, and they’re willing to put doctors in a very sensitive position with gag orders. Physicians have their hands tied here and the lack of clarity in the law makes it even harder to determine what’s legal for them, and what might get them sued by Halliburton or another huge firm that they can’t possibly hope to beat.

Physicians need to be able to think about their patients first, and to focus on the best care for them, working with patients on an individual basis to assess needs and situations and determine how to move forward. Anything that interferes with that is dangerous, whether it’s an order to read explicit misinformation about fetal development to someone seeking an abortion, or a law allowing you to access information about what might be killing your patient at the price of never telling anyone about it. The fact that multiple states have such fracking gag laws is troubling, and of course defenders of the laws say that the opposition to the law is clearly coming from people who don’t like fracking.

Well, yes. That’s part of it. But it’s also coming from people who are concerned about public health and safety, and who are well aware that transparency and openness are critical when it comes to protecting the health of the population overall. Tracking chemical exposure is one way to determine whether chemicals are dangerous when they’re in use in the long term, because the dangers of chemical compounds aren’t always readily apparent in development. Researchers interested in assessing the safety of fracking need access to this information just as much as individual patients and doctors do, and hiding it from them will make it that much harder to connect the dots when it comes to clusters of illnesses.

Which is, of course, the industry’s goal with pushing for such legislation. It knows that fracking is dangerous, it knows that there’s a growing public awareness about the issue, and it knows that the last thing it wants is for people to be able to add it up. Fracking is a cancer, and the industry wants doctors to be able to see the cancer, but not talk about it. To somehow provide patients with information about treatment options without telling them what, exactly, they have. To send patients away with the knowledge that the cancer might recur or pop up somewhere else, and the patient will have no idea, because the patient didn’t know it was cancer in the first place.