Our hearts and prayers go out to the families of the students and professors who were slain in Virginia. Their deaths are a great tragedy for the entire nation. We need to understand the failures that led to this disaster.
Former Pennsylvania Gov. Tom Ridge and others recommend that college students sensitive psychiatric and medical records be shared with parents, universities and the police; this would do more harm than good. They believe that access to more information could have prevented this tragedy, but there was no lack of information about the gunman. Cho Seung-Hui's doctors, the police and the courts all had adequate information to ensure his treatment (or at least restrain him as a stalker) and to ensure public safety. Those who needed the information had it, but they failed to exercise good judgment or use common sense to act appropriately.
Eliminating privacy laws is not the cure for the Virginia massacre. Every disaster brings another call to violate the privacy of every American, as if widespread electronic surveillance of the nation's sensitive medical records will cure all evils, but it won't.
There may be situations where laws are silent, appear to prevent appropriate actions or lead to conclusions that defy all logic and common sense. There will never be laws to cover every possible situation, so we rely on longstanding ethical and moral principles to guide our judgment and to help us take humane actions.
Doctors swear by the Hippocratic Oath to put patients first and guard their secrets; but the highest ethic in Medicine is to save a life; it trumps privacy and it trumps laws that prevent the sharing of private information. If someone is a threatall bets are off. Medical ethics require doctors to do everything in their power to stop that person from doing harm, including violating that person's privacy by calling parents, police or schools to get or give information. Cho was committed twice for brief involuntary treatment. Cho's doctors should have asked the court for a lengthy commitment. If the judge disagreed, they should have appealed or asked the police to jail him as a stalker.
Cho was not hospitalized long enough to be able to communicate, to become stable, to develop a working relationship with his doctor, for his thoughts to become normal or to be ready to continue treatment outside the hospital.
Cho did not get adequate treatment. The responsibility for that fact belongs to his doctor(s) and the judges who had enough information about him. His reported behavior sounds more like schizophrenia than depression, yet he was on an antidepressant. When someone is so obviously and severely impaired, lengthy hospitalization is often necessary to make the correct diagnosis and find effective medications and therapy.
Cho's psychiatrists could have been negligent, incompetent or inadequately trained. Managed care eliminated long-term hospitalization for mental illness, so doctors trained since the 1980s no longer have the experience of managing people who desperately need to be in a hospital during treatment. Insurers and the states won't pay for the inpatient treatment that people with severe mental illnesses need to recover and return to their lives.
This disaster is a direct result of the destruction of the nation's mental healthcare system by managed care and private corporations, not overreaching privacy laws. Before managed care and Wall Street destroyed the mental healthcare system, the dollars spent on mental health treatment were 8% to 10% of total healthcare dollars. Now the amount is 1% to 2% of total healthcare dollars. It's impossible to have an effective mental healthcare system at this level of funding, considering the cost in lives at Virginia Tech and to families with a member suffering from severe mental illness.
Yet the lack of a decent mental health treatment system does not absolve physicians from their ethical duty to save lives and provide the care their patients need.
Sharing every college student's sensitive psychiatric and medical records with parents, universities and the police is cheap and easy but unfortunately not a panacea. In fact, without privacy fewer students will seek and/or receive treatment, leaving those with mild depression, as well as those with severe mental illness, to cope on their own without professional help or authorized medication. In order to prevent another massacre, we should fund a real mental health system and stop easy access to weapons, rather than invite more government intrusion into our private lives and struggles.
Deborah Peel, M.D.FounderPatient Privacy Rights FoundationAustin, TexasTo submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.