Letters to the Editor - Nov. 21, 2005

There is a little understood, pernicious ripple effect of high liability premiums - Legal ethics and medical ethics are "as incompatible as oil and water" - Those who oppose abortion ultimately will prevail

There is a little understood, pernicious ripple effect of high liability premiums

Regarding "Liability premiums stabilizing, but still painfully high-priced" (Article, Nov. 7): The cost of liability, people believe, is a problem for the doctor to worry about.

However, it has not been adequately publicized that this is not just a problem for the rich doctor but it is a major factor in health care costs, not just care but medication, supplies and equipment, etc. Comparative data from other countries should be publicized. Some job loss is due to health care costs. ERs are used at the last minute for problems that could have been fixed in the office earlier, better and more cheaply. I think the AMA and local societies should devote time to this. I closed my office because I couldn't meet the insurance bill in 1990.

--Charles J. Lapp, MD, Sterling Heights, Mich.

Legal ethics and medical ethics are "as incompatible as oil and water"

Regarding "Global look at tort struggles offers glimpse of reform" (Article, Oct. 10): Looking at other countries' experiences in dealing with medical liability is important.

It is interesting, but not surprising, that those countries that do not depend on adversarial litigation as their primary method of dealing with liability have lesser problems with insurance than those that do.

Clearly, in medicine, the adversarial process that drives the tort system is out of place in most instances. This is something that doctors are reluctant to declare publicly for fear of appearing self-righteous. Yet it is obvious, as experience has shown that legal ethics and medical ethics are diametrically opposed and cannot ever really find enough common ground to grind out a reasonable solution that pleases both sides.

Medicine's ethics are based on empathy and science and balancing the two to relieve suffering and prevent disease. On the other hand, legal ethics are grounded in argument and adversarialism. Win at all costs, even if the truth somehow gets twisted and deformed in the litigation process, is the trial lawyers' mantra.

Trying to reconcile these two opposing philosophies only broadens the schism that already divides the two professions. They are as incompatible as oil and water.

Looking to other countries' experiences makes good sense. Although one can argue that in countries where administrative procedures are used in place of the tort system, the people are less litigious and the health care system is government-sponsored, that is no reason to consider administrative compensation systems as poor choices for the United States.

The AMA would be wise to continue pursuing options other than caps on pain and suffering. Taking medical liability out of the courtroom altogether, away from the perverse incentives that feed it, like contingency fees tied to prospects of multimillion-dollar payouts, extortion-like procedures that force innocent doctors to settle and medical experts who are tempted to act as hired guns if the price is right, is an idea whose time has come.

--Edward J. Volpintesta, MD, Bethel, Conn.

Those who oppose abortion ultimately will prevail

Regarding "Abortion training: Hard to get?" (Article, Oct. 24/31): It is tragic that abortion, the deliberate killing of a human being both physician and mother have a duty to nurture and protect, not slaughter, has become a "routine" procedure in the eyes of most of medical academia and journalism. But it is not so in the eyes of most physicians.

Providentially, availability of abortion is declining, as more and more physicians and medical residents have access to information not controlled by medical school faculty and mainstream journalists. They can see for themselves that the fetus is simply a human being at a certain stage of development, and that killing that human being is no different morally from killing any human being.

I look forward to abortion continuing to decline in this country. The demographics seem to be driving this. After all, those who support legal access to abortions are supporting the killing of future citizens who might have voted for access. Those of us who are against abortions are out-reproducing those who are for it.

--Jeremy Klein, MD, Louisa, Ky.