Life as a Physician
Dr. Alexander attended the University of Virginia Medical School between 1955-1959 and completed his residency at the University of Alabama. Throughout his schooling, Dr. Alexander does not remember having explicit classes on medical ethics or informed consent, which at the time, had not been a phrase(2). He recalls his first ethics seminar was at Washington and Lee, his alma mater, at a medical convention in the late 70s. The seminar, though, had nothing to do with medicine and was given by a religion and ethics teacher(3).
(4)
He specialized in rheumatology to become a primary care doctor and rheumatologist. In the practice of rheumatology, which deals with a broad range of things from autoimmune diseases to joints, there can be high risk in treatment. Informed consent forms are often thought of as being for surgeries and procedures but can be used just as well for treatments and medications(5). It is important that the patient understands the potential risks, and with the high stakes of medicine and serious legal threats towards physicians, these forms are crucial in protecting both parties. Dr Alexander first recalls encountering these forms in the 80s or 90s as formal legal documents(6). |
(7)
Dr. Alexander also served on Roanoke’s ethics committee when he moved to Virginia. He would visit local hospitals and settle disputes over ethical issues often dealing with family members(6). Ethics committees were started around this time to deal with medical ethics issues such as when to terminate life support and how to choose organ transplant recipients and donors(7). With the increase in medical research, many new advancements were taking place without having any legal or ethical rules and steps put in place to protect the patients and eliminate complex questions.
For example, the case of Karen Ann Quinlan in 1976 dealt with a young woman who was on life support in a ten-year-long coma and the decision needed to be made whether or not to take her off of it and pull the plug(8). Her parents wished that she die with dignity instead of living in a comatose state for the rest of her years, but doctors refused. This being a new issue, ethical boards and ultimately the Supreme court had to come up with the steps to legal terminate life support, starting with the consent from the family, who had the ultimate say in whether or not to terminate life support, not the doctors(9). You also need to perform all sorts of tests such as a neurological consult to confirm brain death with an EEG, the patient does not respond to painful stimulation, cannot breathe without a respirator, requires a cardiac stimulator or pacemaker to survive, and is in an overall vegetative state(10).
(11)
Now, after a highly successful career, Dr. Alexander is an independent contractor with the federal government serving as the medical expert witness in court, presided over by a judge, in cases where people who attempt to file for disability have been turned down twice already and turn to Dr. Alexander as a last hope. He works for the Office of Hearing Organization (OHO) or as Dr. Alexander loves to joke, the Santa Clause Organization, hohoho(12). With legal permission from the patient, he reviews their medical history and records as well as forms filled out by doctors and hospitals regarding their disabling injury, often over a thousand pages of medical documentation. He is under the oath of truth and is required to be impartial when giving his medical advice on whether or not the patient is disabled or not(13).
Being a doctor is not an easy task with the intensive schooling, the potential legal complications, and having the responsibility of someone's life. Dr. Alexander often thinks of his job and training as a mountain. He says that you must always look to the summit, the purpose of all of the hard work, to keep moving forward: helping people(14). That is what being a doctor is all about. With informed consent and medical ethics, it protects that sacred line between doctor and patient and allows doctors to do their job and help others.
Dr. Alexander also served on Roanoke’s ethics committee when he moved to Virginia. He would visit local hospitals and settle disputes over ethical issues often dealing with family members(6). Ethics committees were started around this time to deal with medical ethics issues such as when to terminate life support and how to choose organ transplant recipients and donors(7). With the increase in medical research, many new advancements were taking place without having any legal or ethical rules and steps put in place to protect the patients and eliminate complex questions.
For example, the case of Karen Ann Quinlan in 1976 dealt with a young woman who was on life support in a ten-year-long coma and the decision needed to be made whether or not to take her off of it and pull the plug(8). Her parents wished that she die with dignity instead of living in a comatose state for the rest of her years, but doctors refused. This being a new issue, ethical boards and ultimately the Supreme court had to come up with the steps to legal terminate life support, starting with the consent from the family, who had the ultimate say in whether or not to terminate life support, not the doctors(9). You also need to perform all sorts of tests such as a neurological consult to confirm brain death with an EEG, the patient does not respond to painful stimulation, cannot breathe without a respirator, requires a cardiac stimulator or pacemaker to survive, and is in an overall vegetative state(10).
(11)
Now, after a highly successful career, Dr. Alexander is an independent contractor with the federal government serving as the medical expert witness in court, presided over by a judge, in cases where people who attempt to file for disability have been turned down twice already and turn to Dr. Alexander as a last hope. He works for the Office of Hearing Organization (OHO) or as Dr. Alexander loves to joke, the Santa Clause Organization, hohoho(12). With legal permission from the patient, he reviews their medical history and records as well as forms filled out by doctors and hospitals regarding their disabling injury, often over a thousand pages of medical documentation. He is under the oath of truth and is required to be impartial when giving his medical advice on whether or not the patient is disabled or not(13).
Being a doctor is not an easy task with the intensive schooling, the potential legal complications, and having the responsibility of someone's life. Dr. Alexander often thinks of his job and training as a mountain. He says that you must always look to the summit, the purpose of all of the hard work, to keep moving forward: helping people(14). That is what being a doctor is all about. With informed consent and medical ethics, it protects that sacred line between doctor and patient and allows doctors to do their job and help others.
1. Stethoscope. Photograph. Gulf Coast State College.
2. Hadden Christopher Alexander, III. Interview by the author. Richmond, Va. March 17, 2018
3. Ibid.
4. Rheumatology. Photograph. Mid-Maryland Musculoskeletal Institute.
5. Alexander. Interview by the author. Richmond, Va. March 17, 2018
6. Ibid.
7. Ibid.
8. Robert D. McFadden. "Karen Ann Quinlan, 31, Dies; Focus of '76 Right to Die Case." The New York Times (New York City, NY), June 12, 1985.
9. Ibid.
10. Alexander. Interview by the author. Richmond, Va. March 17, 2018
11. Karen Ann Quinlan. Photograph. Wikipedia.
12. Alexander. Interview by the author. Richmond, Va. March 17, 2018.
13. Ibid.
14. Hadden Christopher Alexander, III. Interview by the author. Emerald Isle, NC. July 29, 2017.
2. Hadden Christopher Alexander, III. Interview by the author. Richmond, Va. March 17, 2018
3. Ibid.
4. Rheumatology. Photograph. Mid-Maryland Musculoskeletal Institute.
5. Alexander. Interview by the author. Richmond, Va. March 17, 2018
6. Ibid.
7. Ibid.
8. Robert D. McFadden. "Karen Ann Quinlan, 31, Dies; Focus of '76 Right to Die Case." The New York Times (New York City, NY), June 12, 1985.
9. Ibid.
10. Alexander. Interview by the author. Richmond, Va. March 17, 2018
11. Karen Ann Quinlan. Photograph. Wikipedia.
12. Alexander. Interview by the author. Richmond, Va. March 17, 2018.
13. Ibid.
14. Hadden Christopher Alexander, III. Interview by the author. Emerald Isle, NC. July 29, 2017.