Topic: Professions & Institutions

Ethics and the Bullet in the Forehead

Joshua Bush, 17, has a bullet in his head. But he doesn’t want it removed because it will probably prove that he is guilty of attempted murder. More than once, a court has ordered a search warrant that would make it legal to extract the bullet with a bizarre search and seizure with probable cause to be carried out in Bush’s skull. However, no doctor or hospital will perform the “search” for the police. Bone has begun to grow around the bullet, and the operation would take general anesthesia. That means an invasive procedure, and medical ethics forbid operating on a patient without his consent.

Bush is in jail on charges of participating in the robbery of a used car lot with a gang. After officers had left the scene following the robbery, the lot owner was confronted by a figure in the shadows who warned him not to help authorities with the investigation. The figure, whom the owner could not identify, shot at him, and the owner, a competitive pistol marksman, returned fire. He is convinced he hit his assailant. When the robbery investigation led to Bush’s arrest as a participant, lo and behold! He had a newly lodged 9 mm bullet barely under the skin of his forehead. As Ricky Riccardo would say to Lucy, “‘Splain!” Bush, however, isn’t explaining anything. And he likes that bullet right where it is. No doctor is willing to defy his wishes.

How can it be ethical for doctors to refuse to perform a minor operation that will solve a crime? Isn’t ethics supposed to be about doing good?

Of course. But doing good requires establishing principles, guidelines and rules, and the principle of medical ethics that forbids forced invasive techniques is definitely a valid one. Allowing anyone to exert power over another and defy his will is dangerous. The law can’t make anyone testify against himself, and no court will force someone to work for another, even if there is an enforceable contract. The principle of human autonomy sometimes trumps the interests of the state, because once a society starts favoring the state over the individual, freedom is in peril.

Bush admits participating in the robbery, but not the shooting; he has no explanation for how the bullet happened to meet his skull. His mother, amusingly, has been quoted as being certain that the bullet is unrelated to the shooting, because her son is “no criminal.”

He just helps out with robberies and happens to stick his face in the way of bullets.

Skepticism aside, Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, told the Associated Press that Bush’s rights as a patient would probably frustrate the state’s desire to get the bullet. This might mean that Tammie Bush’s good boy will only serve time for the heist, not the shooting. At last report, law enforcement officials had resigned themselves to trying to make the attempted murder case without the bullet, and that might be difficult.

All in all, Joshua’s lucky break isn’t too great a price for us to pay to hold the line against state-ordered operations, which in some countries (including the U.S.) have included lobotomies, sterilizations, or worse. Let’s let Joshua keep his bullet as a souvenir of both the rap he might beat and an ethical principle that is worth more to our well-being than bringing one punk to justice.

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