医学伦理专家：特朗普前医生应该被吊销行医执照

两周前，特朗普的前主治医生哈罗德·伯恩斯坦恩在接受CNN采访时爆出猛料，称其2016年大选期间为特朗普开出的健康证明完全是由特朗普口述的。他表示：“整封信都是由他口述的，不是我写的。后来我只得配合他们演戏。”就此，美国一知名医疗道德专家对《财富》表示，如果此事是真的，再考虑到伯恩斯坦恩曾经泄露过特朗普偷偷吃生发药的事，他很有可能遭遇法律和伦理的双重审查，其行医执照“绝对应该被吊销”。

伯恩斯坦恩则表示，2017年2月，他在接受《泰晤士报》采访时泄露了特朗普吃药生发的小道消息后不久，他就遭到了白宫人员的一次“突然袭击”，这也标志着他与特朗普的关系彻底决裂。2016年，伯恩斯坦恩曾给特朗普开出了一份略显夸张的健康证明，称特朗普是美国有史以来“最健康的候选人”，他的体检结果“令人惊讶地好”。这些话虽然极像特朗普本人的用词，但确实打消了不少人对老人执政的担忧。

此前伯恩斯坦恩一直表示，这份诊断证明是由他“亲自”主笔的，但现在他的态度却来了一百八十度大转弯。美国著名生物伦理专家、纽约大学兰贡医学中心医疗伦理部主任亚瑟·卡普兰医生认为，伯恩斯坦恩很可能会因此事受到纽约医学委员会的责难。

卡普伦在接受《财富》采访时表示：“伯恩斯坦恩的行医执照的确有被吊销的风险，因为此事属于欺诈。他绝对应该被吊销执照。在总统大选期间，伯恩斯坦恩曾数次提及自己写过那份诊断证明。这不仅是欺诈，而且造成了更严重的后果。”《财富》通过伯恩斯坦恩的办公室试图联系他本人，但他的一位代表拒绝评论此事。

卡普兰表示，理论上讲，伯恩斯坦恩的爆料有可能同时引来联邦和纽约州两个层面的处罚，不过他认为，这种处罚可能不会超过官方批评或警告的范畴。“他公开谈及了特朗普服用的药品，根据《健康保险流通与责任法案》（HIPAA），这种做法在法律和伦理上都是不被允许的。”但卡普兰也承认，事情或许不会发展到如此严重的地步。因为如果要对伯恩斯坦恩动用法律手段，特朗普就要提出伯恩斯坦恩违反了HIPAA的主张，而特朗普方面不太可能就此事大肆声张。“除非是存在强奸、谋杀或非法药物交易等情形，要想吊销一个人的行医执照也并不那么容易。”

休斯敦的安德森肿瘤中心医生阿尼邦·梅特尔则在推特上表示，伯恩斯坦恩承认自己在“体检门”中参与作假一事，很可能涉嫌违反纽约州的法律。“允许、协助、教唆无行医执照人员从事需执照才能从事的行为”这一条款，的确是纽约州职业办公室对医生渎职行为的定义之一。

“让无执照的病人口述正式医学证明，或已违反了纽约州法规 。

——阿尼邦·梅特尔

卡普兰认为，伯恩斯坦恩的行医执照吊不吊销都是小事，重要的是，如何保证总统候选人的健康状况得到正确评估。他指出：“我们应该有一个更好的体系，总统候选人的健康状况应经过独立的医学评估。”当然，这不等于可以公布一些无关的个人信息（比如吃不吃生发药之类的问题）。不过独立评估至少可以让公众了解总统候选人的真实健康状况，同时可以避免假医学证明这种丑闻再度发生。（BT365的网址是多少）

译者：朴成奎

On Tuesday, President Trump’s former doctor Harold Bornstein dropped a bit of a bombshell in a CNN interview, claiming that the glowing doctor note he wrote for then-candidate Trump in 2016 was actually dictated by Trump himself. “He dictated that whole letter. I didn’t write that letter,” Bornstein said Tuesday. “I just made it up as I went along.” If that’s true, and combined with Bornstein’s public revelations to the New York Times about President Trump’s hair growth medication, Bornstein may be in some pretty serious legal and ethical hot water—and “absolutely should lose” his medical license, one of the country’s leading medical ethicists tells Fortune.

Bornstein claims that he faced a “raid” shortly after his February 2017 Times interview revealing the hair drug tidbit. That would suggest a major relationship change between Trump and Bornstein from 2016, when Bornstein’s medical note made what many considered hyperbolic assertions about the candidate’s health. Bornstein’s note claimed Trump would be the “healthiest individual ever elected” and that his laboratory tests were “astonishingly excellent”—wording that appeared to mimic the vernacular of one Donald Trump.

Now that Bornstein is claiming the original letter was essentially dictated by Trump (a stark turnaround from his previous assertions that the physician “really” wrote the letter himself), the gastroenterologist might face censure by the New York medical board, according to Dr. Arthur Caplan, the founding director of the Division of Medical Ethics at the NYU Langone Medical Center in New York and one of the nation’s most prominent bioethicists.

“It does risk Bornstein’s license because it’s fraud,” Caplan told Fortune in an interview. “He absolutely should lose his license. In the middle of a presidential campaign, he said he’d written [that letter] a couple of times. That’s fraud and has bigger consequences.” Fortune reached out to Dr. Bornstein through his office, but a representative declined to comment.

Bornstein’s actions could, theoretically, risk both state and federal blowback, Caplan said—although he doesn’t think anything stronger than an official censure or warning is likely. “He talked about Trump’s medications publicly. That’s a big no-no with both ethical and legal implications under HIPAA,” Caplan explained, referencing the federal medical data privacy law. But, he admitted, things aren’t likely to go that far since Trump would have to make a HIPAA violation claim. “Short of rape, murder, or drug dealing, it’s hard to lose a license.”

Dr. Anirban Maitra, an oncologist at the MD Anderson Cancer Center in Houston, pointed out on Twitter that Bornstein’s admission about the dictated doctor note could amount to misconduct under New York law. “Permitting, aiding, or abetting an unlicensed person to perform activities requiring a license” is indeed listed under the state’s Office of the Professions definitions of professional misconduct by doctors.

Letting your unlicensed patient dictate an official physician letter may be a misconduct under NY state regulations. Just saying.

— Anirban Maitra

Regardless of how the Bornstein saga plays out, Caplan asserts the bigger problem is the way in which presidential candidates’ health is assessed. “We have to have a better system. Presidential candidates should go through independent medical assessment,” he says. That doesn’t mean revealing irrelevant personal details (such as, say, hair growth medication). But an independent evaluation could go a long way toward informing the public while preventing situations like Trump’s allegedly faked doctor note.