Suffering: Whanganui man Keith Hindson was the patient in a medical misconduct case this month.
Suffering: Whanganui man Keith Hindson was the patient in a medical misconduct case this month.
READING about the painful experience that Whanganui man Keith Hindson has endured (Chronicle; December 7-9) as a result of the professional misconduct of Dr Peter Liston evoked feelings of compassion and also concerns about risk and about the need for resolution that is all too human.
Mr Hindson's suffering of invasive tongue cancer and his consequent anger at the oral surgeon is understandable and should be respected. Its immediacy and the poignancy of his suffering and disability were well described in the articles.
They evoked my memory of a lecture by my professor of surgery, Dr Karl Moyer. Using the most straightforward diagnosis — appendicitis — as an illustration, he described the limits of clinical certainty in the practical discipline of surgery at 85 per cent.
More than 85 per cent correct, as measured by the surgical pathologist's finding of the excised tissue, you're too conservative as a surgeon; less than 85 per cent correct, you're too radical.
Certainty is lessened proportionately as the problems become more complex. Medicine is an art whose practitioners rely on statistical probabilities in order to reach diagnostic conclusions. Absence of certainty is integral to that practice as it is in all science.
That means that there is a degree of risk in medical decision-making. I emphasise this element of risk not to minimise the seriousness and apparent validity of Mr Hindson's injuries or his grievance, but to supply an element of context that cannot be ignored, either.
Understanding that medicine is not about certainty and that risk-to-benefit analysis is a constant in no way diminishes the specific failings admitted by Dr Liston or the findings against him by the Health Practitioners' Disciplinary Tribunal sitting in Whanganui this month. It does, however, bear on the consequences both for the doctor and the patient.
The tribunal fined and assessed costs against Dr Liston. In addition to recommendations for clinical and record reviews for him, there is a life-long censure on his record, a kind of public shaming.
That Mr Hindson felt the punishment was insufficient raises an important set of issues as to the benefit and cost/risk to the victim of an injury of the consequences to the wrongdoer.
In her brilliant, exhaustive study of the issues raised, Anger and Forgiveness: Resentment, Generosity and Justice, Princeton philosophy professor Martha Nussbaum articulates the situation of an aggrieved person.
Anger, in her view, includes the idea of a serious wrong done to someone (with a subtext "unfairly" or "unjustifiably") with the belief that the wrongdoer should suffer some bad consequences, somehow.
The latter comes from a deep-rooted but misleading belief in cosmic balance, and from a wish to recover control in situations of helplessness. But the wrongdoer's suffering does not restore the victim to wholeness.
I would add that the demand for further punishment by the victim of the wrongdoer, and the resentment at its non-fulfilment, adds to the victim's own suffering by extending the relationship in time.
What the society — a tribunal, in this case — does in making its judgment and assessing the degree of consequence is to permit the two to separate, to go their separate ways in life.
Resentment, the continuing of the initial valid anger at injury, binds the victim emotionally and psychologically to her wrongdoer for a sentence that is as long as those feelings persist.
What the victim needs to do is to accept the outcome of the society, or the external judge, not because it is fair but because it is less harmful in the long run to the victim's integrity and wellbeing, than continuing resentment.
There is the story of two monks whose order strongly forbade their carrying anything but an alms bowl.
When they came to a river and a woman begged to be carried across, one of the two carried her over the river.
The other berated his comrade as they walked the next hour. Finally the sinner said: "I only carried her over that small river. You've carried her for the past five miles."
■ Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.
