I am taking this class on intro to pharmacy practice and we are studing ethics in Pharmacy. I am suppose to read this article that has to do with ethics. As I am reading this I come across one of the darkest times of this profession. I am talking about the Robert Courtney case. Here is a little background on this case: RC owned a pharmacy and prepared chemotherapy drugs for cancer patients. He would purchase chemotherapy drugs from sales rep from Eli Lilly (drug company which keeps track of how much med the pharmacy buys and how much they sell), mix drug in-house but with less than half of the full concentration. When FBI had tests done on 6 prescriptions, they found that prescriptions prepared by RC, which should have had 100% of the drug, actually had anywhere from 39%-1% of the cancer drug. RC would bill the patients for full amount. This happened from 1992-2001. RC confessed to diluting 98,000 prescriptions written by 400 physicians and the number of affected patients is approximately 4,200. I am not sure what you know about Chemotherapy but the dose has to be strong enough to kill cells that are going through division. You have to do 3 rounds of chemo and hopefully that will kill all cancer cells and if not all most of them and hope that the rest will be killed by white blood cells (Immune System). If a patient is given a diluted dose of a chemotherapy drug there might be a high probability of patient getting immune to the drug and of course more metastasising of the tumor. As you all know a patient that is going through Chemotherapy gets really sick because while the drug is killing cancer cells it is unfortunately killing healthy cells too that are dividing at the time. For these reason patients on Chemotherapy are weak, there immune system is very low and they experience nausea and vomiting, I think that this goes for almost all patients. There were patients that were not experiencing any of the side effects that chemotherapy exhibits. I was a bit dumbfound when the doctor had not notices that her patient was not getting any of the side affects but here is what Ann Romaker, MD, a pulmonologist in Kansas City said about this case: "If the drug doesn't have side effects, should you be grateful that the patient is not sick or should you be worried that they're not getting the drug? Usually, your first assumption is not that someone is diluting the drugs. You think it's great that you've got a patient who tolerates the drug well"
Defense for RC argued that: -even though the plaintiff received diluted chemotherapy medication, there was no evidence that it caused any significant injury -patient had already lived well beyond the life expectancy of people diagnosed with recurrent cancer
Verdict: Courtney pleaded guilty to all counts and agreed to accept a sentence of between 17.5-30years in prison, to forfeit all of his property, and to provide the government with a full accounting of all his criminal activities and the criminal activity of any other individual involved. He ended up getting 30 years in prison.
All of this started because he wanted to make money to pay debt to government. I am infuriated to read such things. Pharmacy is one of the most trusted professions and here comes this man that with his greedy and irresponsible attitude puts other people's life in line. What is your opinion and feeling on all this matter? Do you think that he should have gotten more than 30 years of prison and how would you had felt if this had happened to someone you know?
[edit: Yes, this is a school assignment. But I've already finished it, so I'm not asking for help. Just wondering if anyone heard about this case, and what you thought.]
[ October 06, 2005, 09:02 AM: Message edited by: Zemra ]
Posted by Tante Shvester (Member # 8202) on :
I was working in a hospice when that case came to light, and it profoundly shocked my patients and their families. Many of my patients at that time had terminal cancer, had gone through all the curative treatments available, and were dying anyway. There was someone in every family who came to me with the question "Could this be somebody's FAULT?" And every family that I dealt with decided not to find the answer to that question. It was too late; it could only cause more pain; they didn't have the strength and energy to pursue it.
quote:What is your opinion and feeling on all this matter? Do you think that he should have gotten more than 30 years of prison and how would you had felt if this had happened to someone you know?
My opinion of this matter is that there is evil in the world, and this is what it can look like. I have no idea if 30 years is the appropriate sentence. I can't imagine how penance can be done in any amount of time.
How would I feel if this happened to someone I know? You mean if someone I know endangered the lives of others for selfish reasons? I would be appalled, of course. If this person was a friend, I would have to seriously talk with him to see if I could maintain that friendship. I would try to counsel him to do all that is possible to make ammends, if not in full, then at least in some small part.
Posted by Dagonee (Member # 5818) on :
My opinion: he should never get out of prison. Ever.
If this was a federal prosecution, then there is no parole, so he will serve the full 30. That's good.
But I'd have charged him with 98,000 counts of mail or wire fraud, and then looked very hard to find a suitable case for murder charges.
I'd have gotten the state prosecutors to file reckless endangerment charges, one for each affected patient, and, if that didn't give him a large enough sentence, state fraud charges as well.
I'd have thrown every single thing I could think of at him.
Posted by KarlEd (Member # 571) on :
I agree with Dag 100% on this one.
Betrayal of public trust is a big hot-button issue with me and I have very little mercy for people like RC. I think what he has done is far worse than a thug shooting someone and taking his wallet and should be punished accordingly, x 98,000.
Posted by ludosti (Member # 1772) on :
The whole thing is reprehensible. I'm with Dag and KarlEd, though I think he should have been charged with 98,000 counts of attempted murder. The result of his greed was, in effect, an attempt to hasten the end of those people's lives (by reducing the effectiveness of their treatment).
Posted by Dagonee (Member # 5818) on :
I don't think attempted murder would work, except in states that allow attempted murder based on recklessness. Very few do. Generally, attempt requires intent.
The problem with the murder charges is identifying cause of death. This has to be done individually. I bet we could figure out statistically how many people died because of this, but that's not enough to prove murder.
Posted by ludosti (Member # 1772) on :
Attempted murder isn't the same as murder though, is it? What about reckless endangerment or attempted manslaughter?
Posted by Dagonee (Member # 5818) on :
quote:a person is guilty of Reckless Endangerment in the First Degree when, under circumstances evincing a depraved indifference to human life, that person recklessly engages in conduct which creates a grave risk of death to another person.
...
[A person recklessly engages in conduct] when he or she engages in conduct which creates a substantial, unjustifiable, and grave risk of death to another person,
and when he or she is aware of and consciously disregards that risk,
and when that risk is of such nature and degree that disregard of it constitutes a gross deviation from the standard of conduct that a reasonable person would observe in the situation.
...
Conduct evincing a depraved indifference to human life is much more serious and blameworthy than conduct which is merely reckless. It is conduct which, beyond being reckless, is so wanton, so deficient in moral sense and concern, so devoid of regard for the life or lives of others, as to equal in blameworthiness intentional conduct which produces the same result.
There are lesser charges if the depraved indifference doesn't exist.
Posted by Seatarsprayan (Member # 7634) on :
98,000 counts of reckless endangerment. Punishment: death.
Posted by Dagonee (Member # 5818) on :
Probably one count per patient rather than one per prescription. Should still be enough to get an effective life sentence if you can get consecutive sentences.
Posted by Tante Shvester (Member # 8202) on :
If I recall correctly, he would have gotten away with everything, if it hadn't been for the drug rep looking after his OWN bottom line. A drug rep noticed that sales were down, and visited the oncologists to find out why they were prescribing less of his company's drugs (figuring that they were using a different protocol for some reason). The oncologists said that they hadn't changed their prescribing practices. The drug rep investigated further and found that a common link was this pharmacist.
That's how he got caught.
Posted by Enigmatic (Member # 7785) on :
Posted by Sterling (Member # 8096) on :
4,200 patients is a lot of people. But cancer patients frequently die even after undergoing chemotherapy. The pharmacists' actions were stupid, selfish, and reckless, but not vindictive, predatory, or malicious. They're despicable, but I can't equate them with murder or attempted murder. The reckless endangerment charge would seem to fit. I hope he spends the whole thirty years in prison. He certainly shouldn't ever be allowed anywhere near a phramacy again.
Posted by Dagonee (Member # 5818) on :
quote:But cancer patients frequently die even after undergoing chemotherapy.
Small comfort to the patients who died after getting 1% of the medicine they should have. This guy absolutely killed someone. Probably many someones. Adjuvant treatment (chemo after surgery) can improve survival rates significantly. Some cancers are only treated with chemo. Over 4,200 patients, a 5% survival rate difference would equate to maybe 210 deaths.
If there were a way to charge him with murder, I would support it.
quote:The pharmacists' actions were stupid, selfish, and reckless, but not vindictive, predatory, or malicious. They're despicable, but I can't equate them with murder or attempted murder.
It was certainly predatory (given to exploiting others for ones own gain) and mailicious (deliberately harmful).
Posted by archon (Member # 8008) on :
Pharmacists should all be replaced by machines. It's just not a job for humans. If a pharmacist can NOT give someone a perscription that they have been assigned by a doctor, it's a failure of our health system. I have a cousin who is a pharmacist and I still believe that all pharmacists should be fired.
Posted by lem (Member # 6914) on :
quote:If I recall correctly, he would have gotten away with everything, if it hadn't been for the drug rep looking after his OWN bottom line.
These days I am trying to loose weight. My method is to park my car 40 minutes from my house after work (at my second job) and walk home. In the morning, I have to walk to my second job to pick up my car to go to my first job.
2 40 minute walks a day have given new time to think and ponder about life. Today I was thinking about something along these lines, albeit much more generic.
I was thinking about crime and punishment. We live in a capitalistic world. It is the only world I know, and I am quite pleased with it. The result is that money is always the bottom line.
I don't know what I would do with this individual case, but I am glad someone was looking after the bottom line. I think criminal behavior needs more checks and balances to ensure it is not financially viable to commit crime.
If pharmacies have the RC type of problem, then the financial gain of other representatives to interfere needs to be in place so they can police themselves. It seemed effective in this case. Maybe there could be changes in institutional guidelines that benefit the profession as a whole as they follow the guidelines with a result of policing themselves.
I don't know what I am saying. It is late. I am tired. But this case has meandered into my earlier thoughts from my walk. Goodnight. Posted by Tante Shvester (Member # 8202) on :
Or maybe just your cousin.
I seriously would have a problem with a pharmacy machine. The pharmacist is an important player in the health care team.
Why not say that any profession that has had badly-behaved members be replaced by machine?
We could have machines teach our kids at school. We could have machines lead our religious communities. We could have machines star in Hollywood movies.
Wait, that last one sounds kind of cool.
Posted by Enigmatic (Member # 7785) on :
I am not given to using graemlins often. My previous post is almost definitely the most I've ever put in one post. But when I read this thread earlier today I could not get words out without sobbing.
In junior high and highschool I had 2 best friends. The three of us did just about everything together. One of them got cancer. He went through radiation and chemo for a very long time and the cancer looked like it was going into remission. The doctors wanted to hit him with one last huge dose of radiation and chemo to drive it further into remission, but wanted to wait a few months to give his body a chance to recover from the sickness of the treatments before doing that final treatment. Well, in that time the cancer recovered too and it grew quicker and stronger than before and the next thing I knew my best friend was dead.
Now. Considering how angry I was at the doctors, who were really just doing what they thought was best for him... If I'd found out that some scumbag pharmacist had skimped on his chemotherapy prescription to make a buck, the murder charges being discussed here would be mine and the murder would been the pharmacist's.
I am not a violent person. Rationally, I do not think violence solves anything. But honestly, trying to picture myself in this situation I think I would have done my level best to force feed that guy every pill in his pharmacy and staple his throat shut so he couldn't vomit them back out.
And after all, he was going to die eventually anyway, so that wouldn't be vindictive, predatory, or malicious.
--Enigmatic
Posted by Zemra (Member # 5706) on :
Because he was willing to work with the government he actually got a break. And by the way this was a federal case and FBI was involved in the sting operation. The report said that during the time that he had been diluting the drugs there was only one person that had died and they are not sure if it was because of diluted Chemo drug or just because of the cancer. I would still want him to stay in prison for the rest of his life. This case touched me not only because pharmacy is my profession but also because cancer is such a sensitive subject for me. My aunt passed away after many years of fighting breast cancer. Knowing the hardship that she had to deal with, it is impossible to portray the pain and the devastation that she went through. She died feeling every pain in her body without the possibility of Chemotherapy that might have saved her life or medications that might have decreased the pain. When I read this article, I felt the pain of my aunt dying all over again. If someone is responsible in doing such a terrible deed, I would sustain any punishment the law saw fit to give him. I am not a vindictive person. I hate to have to take sides against someone in my own profession. But the only difference between Mr. Courtney and a common street criminal who slits an innocent person’s throat for his wallet is that Mr. Courtney got to know these people first. He made them trust him, looked into their eyes and the eyes of their families, and let them die for money. If he gets a moment of peace or happiness in this life or the next, it will be too good for him.
Posted by Sterling (Member # 8096) on :
I'm just saying that murder generally implies intent to kill. I'm not saying he shouldn't be punished harshly. By all means, lock him up and throw away the key.
But do remember, cancer was the key to the people's deaths. What the phramacist did was deny them a chance to get out of the way of a speeding truck. He didn't put them in front of the truck in the first place.
To a way of thinking (and I know this is horrible), the crime was less than murder simply because most of those victimized never knew of their victimization. A murder victim frequently would. Cold comfort, certainly...
I judge Mr. Courtney quite harshly, but I wouldn't equate his actions with murder. It's just not that simple.
Posted by Lyrhawn (Member # 7039) on :
I agree with Dag and the others.
Though for his punishment, I'd say lock him away for life, and every time he gets sick, only give him a half dose of medicine, if any at all.
Posted by Glenn Arnold (Member # 3192) on :
quote:I'm just saying that murder generally implies intent to kill.
1st degree murder yes, but I think the "depraved indifference" simply means that the person was aware that his actions could or probably would result in death and did it anyway. It's still murder.
This guy is a pharmacist. He knew how much damage he could do and did it anyway.
The only problem is that you can't make a clear connection between the "bullet and the gun," because the medicine might or might not have worked, and the cancer might or might not have gotten worse, or whatever. You can't prove he killed somebody. But you can prove he knew his actions would probably kill somebody.
Posted by romanylass (Member # 6306) on :
He is reprehensible- 30 years is not enough.
Posted by archon (Member # 8008) on :
Tante, because pharmacists are NOT important players in the health care team... they're detractors and only serve to get in the way. A machine can do everything a pharmacist can, but better and without idiotic personal interests cropping up.
All those other examples you gave of "misbehaving" professions are not keeping people from their medication due to personal beliefs or in this case money... the examples are apples and oranges and missing the point completely.
Pharmacists need to be replaced.
Posted by Sterling (Member # 8096) on :
Wrong.
A machine can't explain the side-effects of a drug to a patient, or recognize if a patient is confused by the medicine's instructions.
A machine can't tell if a doctor has prescribed the wrong medicine for the patient's particular circumstance. It does happen.
A machine isn't likely to suggest a generic medication that could save a patient money.
A machine can't recognize patterns that suggest a patient is a narcotics-seeker, or tell if the same patient is coming in with multiple prescriptions for the same medication under different names.
A _good_ pharmacist is far better than the most carefully programmed machine.
Posted by Sterling (Member # 8096) on :
Not saying that two wrongs make a right, but has anyone considered that people responsible for introducing chemical compounds that may cause cancer in the first place to the air or groundwater are likely to get little more than a slap on the wrist?
Posted by Enigmatic (Member # 7785) on :
I would not trust pharmacy to our current level of vending-machine technology. Besides, a person is still going to have to load the drugs into the machine at some point anyway, which could lead to the same potential for abuses and probably be even harder to trace back to the culprit.
--Enigmatic
Posted by Glenn Arnold (Member # 3192) on :
I've had quite a few discussions with my pharmacist, and I have to say that he's more forthcoming with information than my doctor is.
Maybe it's because he isn't as pressed for time, or maybe it's because he doesn't have the "I am Doctor I am God" attitude, but he's very helpful, and clearly knows his medicine.
I would not want him to be replaced with a machine. Actually, in my previous employment my health plan required a lot of medications to be ordered by mail, which eliminated the human factor, and I didn't like it at all.
Posted by Joldo (Member # 6991) on :
This is sick. This is disgusting profiteering. This is an argument for vigilante justice, almost. Jeez.
Posted by Dagonee (Member # 5818) on :
quote:What the phramacist did was deny them a chance to get out of the way of a speeding truck. He didn't put them in front of the truck in the first place.
Which would be murder, plain and simple. It is absolutely as bad as pushing someone in front of the truck.
quote:On Law & Order, sometimes they'll talk about charging someone with "Murder 2, reckless endangerment". Are these two seperate charges, or does the reckless endangerment part affect the murder 2 part?
THe jury instruction I quoted above is for the most severe form of reckless endangerment, and includes the "depraved indifference to human life" standard. Murder 2 (in NY and most other Model Penal Code states) includes causing the death due to reckless conduct exhibiting depraved indifference to human life, with pretty much the same definition as the instruction quoted above. The difference between the highest form of reckless endangerment and murder 2 is that the conduct caused the death of a human being in the latter.
The problem here is causation - a specific death caused by this doctor. Since we don't know who would have died even with chemo, we can't show causation.
quote:because pharmacists are NOT important players in the health care team
I wish Alucard were here to refute this. I doubt any of us can do justice to the many things wrong with this statement.
Posted by Speed (Member # 5162) on :
I was going to tackle it myself, but I decided not to feed the troll. This guy doesn't know what he's talking about, and he doesn't care. He's just trying to get a rise out of us.
I'm comfortable letting it go. But I do appreciate those of you who have stood up for my profession here. Posted by Speed (Member # 5162) on :
By the way, the "pushing someone out of the path of a truck" analogy doesn't hold true. If I saw someone in the path of traffic, there are several valid reasons I could have not to help them. It would be a danger to me. I would have no real duty to help them. I might not even have the chance. None of those excuses apply to this guy. His whole, entire job was to help these people. Not only was it what he was trained for, paid for, and swore to do, but he wasn't risking anything or losing anything by giving his patients the medicine that they deserved, and that he was getting paid to dispense. He knew how to do it, and the medicine was readily available to him. He had means, motive, opportunity and sworn duty to save lives, and the reason he declined that opportunity had nothing to do with anything but selfishness.
We may not know who would have lived or died if they'd got the medicine that was ordered. But this guy knew every single time that he diluted a drug that there was a significant probability that it would cost a person his or her life. And every single time he diluted a drug, he made a decision that a little extra change was worth the life of a person and the happiness of their family.
This isn't a Les Miserables story. Pharmacists make a very decent living doing just what they're supposed to do. This guy wasn't making money to feed himself or clothe his children. This is life vs. luxury, and it's one of the most sickening examples of greed and pettiness I've ever heard. He may not have directly killed these patients, but based upon how this reflects his feelings about the importance of human life, I wouldn't be any more eager to meet him in an alley than a Crip or a crackhead. It absolutely disgusts me. I'm not saying I want him to get the death penalty, but if I heard tomorrow that he was shanked in prison, I don't think I'd lose a moment of sleep.
Posted by Dagonee (Member # 5818) on :
Speed, I forgot you were a pharmacist.
quote:If I saw someone in the path of traffic, there are several valid reasons I could have not to help them. It would be a danger to me. I would have no real duty to help them. I might not even have the chance. None of those excuses apply to this guy.
Exactly. He did the equivalent of handing a drowning man a rope and letting go, when there were 10 other ropes the drowning man could have grabbed had not this seemingly good option been presented.
Posted by Sterling (Member # 8096) on :
Of course, none of those ropes are necessarily tied on either.
He did something awful, but cancer was the killer.
How many people die from side-effects of their chemotherapy?
Posted by Dagonee (Member # 5818) on :
He diluted medicine which was being prescribed to save a life. It is absolutely as bad as putting three bullets in a revolver, spinning the cylinder, and firing at the patient.
That's depraved indifference.
Posted by Sterling (Member # 8096) on :
Using chemotherapy is like playing Russian roulette with a revolver with three bullets... As opposed to cancer, which is a revolver with five. With the chemo, you're removing three bullets and replacing one. You're less likely to die of the cancer, but the chemo itself may kill you.
But the metaphors are getting a bit stretched here.
Purely hypothetical, of course, but it's possible that absolutely no one died because of his actions.
And some of the people who've gone on chemotherapy say that if they were faced with the choice again, they'd take pain meds and die of cancer rather than undergo chemo again.
Cancer is awful. I attended the death of a family friend who passed away after his _third_ bout with cancer. Again, I don't dispute what the pharmacist did was awful. I just wouldn't equate it with murder. Reckless endangerment, manslaughter, hell, even arson, at least morally. But not murder.
[ October 08, 2005, 04:23 AM: Message edited by: Sterling ]
Posted by Rakeesh (Member # 2001) on :
I guess I fail to understand the distinction, Sterling. Is it a matter of probabilty?
Suppose that this 'pharmacist' (using the term loosely) had known that he was increasing the likelihood of death from cancer by 10% among his victims by his...what's the word, skimming off the top?
That I suppose could be considered short of murder.
But suppose he knew he was increasing this likelihood by fifty percent? Seventy-five? Ninety? Ninety-nine point nine percent?
Sometimes, arbitrary lines must be drawn to make laws effective. We have to pick an age after which people are treated differently by the law; we've actually picked a number of ages, varying from state to state and crime to crime.
But something like this, Sterling? Your gun analogy doesn't hold water at all. See, his customers had one gun, with say three bullets. They came to him asking for help, as recommended by other doctors. He said, "Sure, here you go,"....and added two more bullets.
It's murder because he choose to risk someone else's life against their will, and because he did it over and over and over again. I believe that sometimes people's intent is different from what they say or believe it is. I suppose this man claims his intent was not to kill anyone...but if he does, he's lying to himself and to others.
If you're an intelligent, educated, experienced person who examines a course of action and its ramifications and decides to take that course of action-as obviously this man did-then I don't care what you say, your intent was everything that happened. You may hope it doesn't happen, but I can go play in traffic too, and hope I don't get hit.
Posted by Dagonee (Member # 5818) on :
quote:Reckless endangerment, manslaughter, hell, even arson, at least morally. But not murder.
If reckless endangerment (at least, the version defined above) results in a death, then it is murder, second degree.
Manslaughter, whether voluntary or involuntary, requires causing the death of a human being.
The only element not present in reckless endangerment is causing the death of a human being.
By admitting that reckless endangerment is an appropriate charge and admitting that manslaughter is an appropriate charge, you are admitting that murder 2 is an appropriate charge.
People are presumed to intend the very likely or almost inevitable result of their actions. If you point a loaded gun at my head and pull the trigger, you intend me to die, whether you actually wanted me to die or not.
Switch the disease to anthrax and the drug to Cipro for a clearer analogy. The different probabilities don't change what's going on here.
Posted by Sterling (Member # 8096) on :
...Fine, murder two, if it will stop the hair-splitting. Not, notably, a capital crime.
Merriam Webster defines murder as:
1 : the crime of unlawfully killing a person especially with malice aforethought
...Which implies either that the intention was murder (which it was not) or a heedless willingness to kill in the commission of another crime (which may be true.)
And yet, still, cancer was the killer. Indifference to suffering may have made some of those deaths possible.
If I fire a shotgun into a crowd and no one is killed, I can't be charged with murder. Assault with a deadly weapon, attempted murder, yatta yatta. But not murder.
Posted by Lyrhawn (Member # 7039) on :
As a pharmicist, he understands the implications of what it means to withhold medicine from someone, and he understands what chemo means to a cancer patient. Therefore everything he did was willful, and with full knowledge of the potential consequences. He KNEW what he did could result in the accelerated death of a patient.
My grandmother died of cancer. If I had found out afterwards that her pharmacist or anyone, was tampering with her medicine for any reason at all, I'd want the maximum punishment allowable unleashed on him. Furthermore, I watched her suffer through hell on that medicine. If I knew that she'd suffered, and there was a possibility that the medicine wasn't even strong enough to do anything, I'd know that she was suffering for nothing, in which case this morally bankrupt man should be charged with torture.
Posted by Dagonee (Member # 5818) on :
quote:...Fine, murder two, if it will stop the hair-splitting. Not, notably, a capital crime.
You're complaining about hair-splitting? You're the one who insisted not murder but manslaughter.
quote:If I fire a shotgun into a crowd and no one is killed, I can't be charged with murder. Assault with a deadly weapon, attempted murder, yatta yatta. But not murder.
But if someone gets hit, survives the surgery, and dies 4 weeks later of a post-operative infection, you can be.
Similarly, if someone else had done the shooting and you went in and replaced his IV antibiotics with water, and he then died of a post-operative infection, you could be charged with murder.
I'm curious as to what your motivation is here. You spend half a thread trying to draw a distinction between this and murder, trying to make very fine technical distinctions, and yet seem to resist having such distinctions made by others.
quote:Merriam Webster defines murder as:
1 : the crime of unlawfully killing a person especially with malice aforethought
...Which implies either that the intention was murder (which it was not) or a heedless willingness to kill in the commission of another crime (which may be true.)
By the way, dictionary definitions of crimes are next to worthless.
The split between murder and murder two happened in Pennsylvania almost two centuries ago. The definition you cited predates that split, and includes both murder 1 and murder 2.
Under the common law definition of murder which that dictionary definition reference, this would certainly qualify (if, as I've said all along, it could be proven). Malice aforethought included implied malice demonstrated by wilful diregard for human life.
Posted by Miro (Member # 1178) on :
This seems to be appropriate. From Xenocide:
quote:"You broke the oath, said Ender. "You betrayed the word of the fathertrees." "No one harmed a hair of his head," said Warkmaker. "Do you think anyone is deceived by your lies?" said Ender. "Anyone knows that to withhold medicine from a dying man is an act of violence as surely as if you stabbed him in the heart. There is his medicine. At any time you could have given it to him."
Posted by Rakeesh (Member # 2001) on :
quote: ...Which implies either that the intention was murder (which it was not) or a heedless willingness to kill in the commission of another crime (which may be true.)
Obviously he was willing to commit the crime of murder during his other crime.
Posted by Miriya (Member # 7822) on :
I have no words to express my contempt for this man.
Posted by aspectre (Member # 2222) on :
The real questions are: Why didn't the manufacturor/distributor notice the disconnect between their sales to the pharmacist and the number of patients/prescriptions much earlier? And why didn't they notify the appropriate authorities much earlier?
Posted by Dagonee (Member # 5818) on :
Why is that the real question? And why do you think they know the number of patients or prescriptions?
I'm wondering what sinister motive you can find for the pharmaceuticals to allow someone to continue selling less of their product than would otherwise happen.
Posted by The Pixiest (Member # 1863) on :
If you replace someone's heart attack medicine with placebos, isn't it attempted murder?
How is this any different?
Shoulda charged him with 98,000 counts of attempted murder and then fried him.
Pix
Posted by aspectre (Member # 2222) on :
Your "sinister" pharmaceutical company, Dagonee, or at least their sales representative was the one who discovered the discrepancy between their sales and the pharmacist's dosages. The company itself was the first to ask for a criminal investigation.
Given that the drug company itself was the first to suspect a crime through review of its own market research and sales records, I do think that it is valid to ask whether the discrepancy could have been found earlier. And whether lives could have been saved IF a more systematic review had been made earlier.
Everybody makes mistakes that can be seen in hindsight. But when a big one is made, it is incumbent to put into place procedures which will prevent the mistake from occurring again. Especially when the mistake occurs through a breakdown in trust. There ain't never gonna be no shortage of sidewinders willin' to abuse other folks' trust.
[ October 09, 2005, 01:43 AM: Message edited by: aspectre ]
Posted by Theaca (Member # 8325) on :
I find it hard to believe that the drug companies keep close enough track of a SINGLE pharmacist to catch the discrepancy earlier. The data would be diluted by his fellow pharmacists in the same pharmacy, and in the same town. Many drugs have several prescribing doses. Maybe more skinny people got X cancer one year. Or more kids. I know drug companies keep track of a lot, but I don't think the amount of monitoring needed to prevent this would be something I want to see put into practice.
Posted by aspectre (Member # 2222) on :
I've been reading about this case from the beginning, Theaca. The pharmacist who was convicted owned the pharmacy. This isn't a case of an employee able to hide his actions behind a chain store's number of pharmacist-employees. And the circumstance leading to the criminal investigation&arrest was as I described.
Posted by Dagonee (Member # 5818) on :
quote:Your "sinister" pharmaceutical company, Dagonee, or at least their sales representative was the one who discovered the discrepancy between their sales and the pharmacist's dosages. The company itself was the first to ask for a criminal investigation.
Yes, I know. That's why I wonder why you think the "real question" involves their actions at all. This is not something drug companies should be spending lots of resources on to detect. The fact that they did is a good thing, not something to berate them for.
Especially not something to say is the "real question" when the real questions should be about the criminal.
quote:I've been reading about this case from the beginning, Theaca. The pharmacist who was convicted owned the pharmacy. This isn't a case of an employee able to hide his actions behind a chain store's number of pharmacist-employees. And the circumstance leading to the criminal investigation&arrest was as I described.
That doesn't change the fact that the factors Theaca described make this something drug companies could catch in only a small number of potential cases. Therefore, expending resources to expand such efforts because one stupid, horrible pharmacist did this in a fashion they might have been able to detect is poor planning.
Posted by Sterling (Member # 8096) on :
quote:You're complaining about hair-splitting? You're the one who insisted not murder but manslaughter.
Because a lot of people seem to equate this act with going up to someone, looking them in the eye, and stabbing them in the heart with a knife, and I don't think that's true. And a lot of people think he ought to be killed for his action in ways that well exceed the idea of cruel and unusual punishment, and I definitely don't think that's true.
You can make a strong case that everyone- EVERYONE- makes decisions every day, through apathy, greed, and laziness, that in some way down the line contribute to someone's death before the full natural life span they might have lived. This man was a lot closer to the bone on such a decision, and he did the wrong thing. He did the wrong thing, knowing in a concrete way the likely consequences, and he did it times several thousand.
For that, he fully deserves to spend thirty years in prison, during which time he can hopefully understand the full weight of society's disapproval of his actions and come to regret what he did in a real way.
But when we say someone is a murderer, we say they're a monster, that they're beyond the pale, that they're not part of what we consider human society.
This guy isn't. He let everyone down, he deliberately botched his duties, he did something greedy and stupid. That's not inhuman. That's all together too human.
Get me? If you don't, at this point we're just going to have to agree to disagree.
Posted by Theaca (Member # 8325) on :
hmm. I think I'd have to call him a monster.
Posted by Allegra (Member # 6773) on :
To know how important is was for these people to get their medication and to deny them a fighting chance? Sounds like a monster to me.
Posted by Sterling (Member # 8096) on :
How many of his patients taking chemo drugs died _before_ he started giving out faulty prescriptions?
Maybe at one time he cared about these people. Maybe after a certain number of people come through your door, get their medicine, and die anyway, you start to harden your heart out of necessity. Maybe he started to convince himself that it didn't matter anyway.
If I'm truly in a company of people who have never done things that they found morally unpalatable but justified them at the time or afterward, however partially, however shakily- I humbly submit myself to your greater wisdom.
If not, maybe you should consider what it would be like to lose thirty years of your life. Yes, I know the automatic reaction is to say how many years the people he victimized lost. Resist the obvious, and actually think about it.
Posted by Dagonee (Member # 5818) on :
quote:But when we say someone is a murderer, we say they're a monster, that they're beyond the pale, that they're not part of what we consider human society.
This guy isn't.
You admitted on the last page that this guy is a murderer.
In many ways, this man is worse than someone who stabs someone else through the heart in an argument. And that person would likely be called a murderer.
Posted by Sterling (Member # 8096) on :
I admitted that I was willing to accept that legally he was guilty of a non-capital offense. If I was faced with a lynch mob that was ready to stuff pills down the man's throat if they felt justice wasn't done, I'd do the same.
If you say the man is a monster and his motivation and origin is something out of the purview of societal norms, you may take that individual out of the picture and you may satisfy your own self-righteous need for vindication and purgation. But you deny yourself the ability for a more careful examination that might prevent the same damn thing from happening somewhere else.
Get over the semantics.
Posted by Dagonee (Member # 5818) on :
Where do you get off saying that to me? I have been very precise in my use of words because we are trying to be very precise in assigning the level of culpability.
This is twice now you have gotten pissy about the use of words.
If you don't want to have semantic discussions don't start them. Especially when you claim to want a "more careful examination."
Careful examinations require precise language.
quote:I admitted that I was willing to accept that legally he was guilty of a non-capital offense.
You admitted that murder 2 could be an appropriate charge. That means you admitted he could be called a murderer.
Posted by Sterling (Member # 8096) on :
I was willing to compromise over the terms on the possibility that such compromise might cause someone to think and consider the situation beyond a very narrow and fixed view. Apparently that was a mistake.
(Erase, rewrite. Erase, rewrite.) The response I'm getting indicates to me that you engage on the terms "murder" and "murderer" without the least notice as to why I might have thought those terms appropriate or inappropriate, or the associations I make with them and think or fear others make with them. Instead, what I'm receiving is "You admitted he was a murderer! You did it- back on page one! Got you!"
I'm frustrated, because what I'm writing is getting engaged on a very shallow level. So I ask you to look past the level of words to the level of meanings. If you were doing that, you might realize that whether or not I said what he did might fit the legal definition of murder 2 is irrelevant.
The response I'm getting is extremely antagonistic. I think all you see is that on some level I disagree with you, so your anger at the situation with the pharmacist is spreading to me.
That is perhaps understandable, seing as how what is said on Hatrack is going to make absolutely no difference in the outcome of this particular case. There is a very small chance someone here might be involved in a similar case some time up the road- as jury, counsel, witness, what have you. But I wouldn't lay long odds on it.
So, I'll try to put this carefully, one last time. Because quite frankly, I've got enough spittle on my glasses, metaphorically speaking.
This particular forum can be a place where everyone gets to agree, "Oh, no! That's terrible! (walla walla walla)" and go on about what a monster this man was and how they'd hang him from the nearest yardarm and bury him in the desert and release the fire ants and pour gasoline over his entire genetic line and light a match. The grand effect of that will be purgation of feelings of outrage that didn't exist before the events were brought to light in this forum in the first place. I would call that a net gain of squat all.
Or we can try to recognize that the seeds of things like this aren't especially uncommon at all, discuss it like civilized human beings, and perhaps come out of this with a few ideas that would actually stop something like this from happening in the future.
When people imagine someone pulling out a gun and shooting someone, or stabbing them with a knife in an alley, only the very fearful imagine it happening to them, and only the very paranoid imagine the act being committed by someone they know. And virtually no one imagines themselves on the side pulling the trigger. The monster. The "murderer."
If we can't envision the mindset that enabled this to happen rather than just condemning it, we accomplish nothing. If we can't contemplate the self-justifications that made this act possible, we can't envision it.
You get down to a word like "murderer", you get a closed loop. Give the average person's imaginary "murderer" a gun, he shoots people; give him a gun, he stabs people; give him a high building, he pushes people off; give him an automobile, he runs people over.
Take the pharmacist out of the pharmacy in this case, you get your next-door neighbor, the guy you come over to to borrow a lawnmower. _Maybe_ some day you hear he's been embezzling from his company and got hauled off to prison and you're kind of surprised- he seemed like such a nice guy! More likely, nothing much ever happens to him, and you don't think about him very much.
Now have you read through this rather lengthy text? Are your fingers itching to fire off a reply to tell me what a jerk I am?
If so, please don't bother. I've spent quite enough time and energy, there's no point in my continuing, and I yield the forum to the lynch-mob. May it bring ye much purgation. It will bring you nothing else.
Posted by Dagonee (Member # 5818) on :
quote:The response I'm getting indicates to me that you engage on the terms "murder" and "murderer" without the least notice as to why I might have thought those terms appropriate or inappropriate, or the associations I make with them and think or fear others make with them. Instead, what I'm receiving is "You admitted he was a murderer! You did it- back on page one! Got you!"
I spent a lot of energy making a specific case and responding to yours, with very valid reasons for what I posted. Stop treating this as a game.
quote:I'm frustrated, because what I'm writing is getting engaged on a very shallow level. So I ask you to look past the level of words to the level of meanings. If you were doing that, you might realize that whether or not I said what he did might fit the legal definition of murder 2 is irrelevant.
It's been engaged on every level. You have simply refused to re-engage - simply to restate your conclusions without adressing the actual elements of your arguments to the objections raised to them.
quote:This particular forum can be a place where everyone gets to agree, "Oh, no! That's terrible! (walla walla walla)" and go on about what a monster this man was and how they'd hang him from the nearest yardarm and bury him in the desert and release the fire ants and pour gasoline over his entire genetic line and light a match. The grand effect of that will be purgation of feelings of outrage that didn't exist before the events were brought to light in this forum in the first place. I would call that a net gain of squat all.
The very fact that you summarize pretty much the entire rest of the thread in this manner shows you've not truly apprehended it. No one has suggested killing his children. Few people have suggested the death penalty.
quote:If we can't envision the mindset that enabled this to happen rather than just condemning it, we accomplish nothing. If we can't contemplate the self-justifications that made this act possible, we can't envision it.
And yet several people, including myself and Lyrnham, have given detailed reasons that specifically relate to the mindset involved here, including the particularities that arise from this man's profession.
quote:You get down to a word like "murderer", you get a closed loop. Give the average person's imaginary "murderer" a gun, he shoots people; give him a gun, he stabs people; give him a high building, he pushes people off; give him an automobile, he runs people over.
That seems to be a problem you have. We use the word "murderer" as "one who commits murder," a word with a fairly precise legal definition. And that's what we mean by it. You have added all this on top of it, then condemned us because the loaded version of the word that you use it closes discussion. This is an issue with you, not us. "Murder" has not prevented detailed examination of this act by anyone except, apparantly, you.
quote: Are your fingers itching to fire off a reply to tell me what a jerk I am?
No, they're not.
quote:I've spent quite enough time and energy, there's no point in my continuing, and I yield the forum to the lynch-mob. May it bring ye much purgation. It will bring you nothing else.
Ah, yes, we're one of those unusual lynchmobs who carefully parse available law to see what the person can be charged with.
Seriously, you are arguing with what's not been said, assigning ridiculous meanings to other people's posts, and we have the perfect example of it here. Especially me, who said that while it might meet the definition of murder, we can't charge him with it because we can't meet the evidentiary burden.
Yeah, such lynch mob.
Give me a break and stop playing the martyr. If you want to discuss it, discuss it. If you want to run off and pout because I actually hold you to what you say and don't let you add meaning to what I say, go ahead.
Posted by Rakeesh (Member # 2001) on :
Sterling,
quote:But when we say someone is a murderer, we say they're a monster, that they're beyond the pale, that they're not part of what we consider human society.
This guy isn't. He let everyone down, he deliberately botched his duties, he did something greedy and stupid. That's not inhuman. That's all together too human.
There's a problem with this, Sterling. The man didn't just 'botch his duties'. It wasn't an accident, what he did. It was cold, calculated, thoughtful, and long-term. What he did was not stupid, it was a clever method of stealing money from the already-afflicted to fatten his coinpurse.
That's beyond the pale, Sterling.
He's still 'human', yes. We lock up for life human beings all the time. And I think we should continue to do so.
You're also mistaken that there's just one idea of 'cruel and unusual' punishment.
Have you ever seen the movie Aliens, Sterling? I realize it's a bit silly of me to make an argument based on a quote from there, but your words have reminded me of a scene from that film.
quote:Burke: I made a decision, and it was...wrong, it was a bad call, Ripley...it was a bad call.
Ripley: Bad call? These people are dead, Burke! Do you realize what you've done here?!
It's the same situation, man. This man cannot have planned his disgusting scheme so well and so thoughtfully without having realized, "This will kill people."
Posted by Rakeesh (Member # 2001) on :
Oh, and reading your post to Dagonee...wahhh! Oh, gods, I realize we've so horribly wronged you! Please o thoughtful Sterling, forgive us! Oh, remorse remorse!
Get over yourself, man. Either quit playing your self-pitying violin, or just take your sob song elsewhere, I say.
Posted by Rakeesh (Member # 2001) on :
Oh, and for the record, my fingers weren't itching to tell you what a jerk you were...until that whining post of yours to Dagonee. And for the record, yes, I recognized the clumsy attempt at manipulation there. I just didn't care. I expect most people around here had the same reacion.
Posted by Sterling (Member # 8096) on :
And your responses are still far more anger than interaction with what I'm saying.
Whether you believe it or not, I'm not trying to manipulate anyone, nor am I trying to make myself into some kind of martyr. I'm asking, in the most diplomatic language I can muster in my increasing frustration, that you cool your rhetoric away from attacks and terms like pissy.
This is bloody ridiculous given that we came into this apparently agreeing on the most basic idea: that the guy deserved a full term behind bars.
I'll grant that I've indulged in some metaphors that sounded good to me in the heat of type but weren't worth the pain to re-explain when others found fault with the metaphor or put forth metaphors of their own. Mea culpa. I've seen discussions get so dragged down in metaphors that the original topic got completely eclipsed. It isn't worth it.
But if you believe that this has been a strictly legal discussion, I'd disagree.
In two pages- TWO- we've received such emotional nuggets as:
quote:98,000 counts of reckless endangerment. Punishment: death
quote:Rationally, I do not think violence solves anything. But honestly, trying to picture myself in this situation I think I would have done my level best to force feed that guy every pill in his pharmacy and staple his throat shut so he couldn't vomit them back out.
quote:he gets a moment of peace or happiness in this life or the next, it will be too good for him.
quote:Though for his punishment, I'd say lock him away for life, and every time he gets sick, only give him a half dose of medicine, if any at all.
quote:This is sick. This is disgusting profiteering. This is an argument for vigilante justice, almost. Jeez
quote:I'm not saying I want him to get the death penalty, but if I heard tomorrow that he was shanked in prison, I don't think I'd lose a moment of sleep.
quote:Shoulda charged him with 98,000 counts of attempted murder and then fried him.
And kindly note, when I changed the precise term from "murderer" to "monster", I immediately got two replies willing to categorize him as the latter.
When you say this pharmacist is _worse_ than someone who stabs someone else through the heart with a knife, you're not arguing a legal definition, you're arguing an emotional one.
I'm perfectly aware that no one suggested going after his family. It was an exaggeration to make a point about some of the things people _have_ suggested doing to the man, because this _hasn't_ been about nothing but strict definitions and legal definitions, but emotional responses.
The tone and topic has shifted from semantic definition to legal definition to emotional context many times. High emotions generally make for bad laws and poorly thought responses to situations.
I've been trying to move towards more thoughtful and less emotional responses. That was, again, the only reason I said I would accept the definition of murder: I was hoping the conversation might move on to something productive like how the actual law should treat a case like this, or how it might be possible cost-effectively to police the trade, or whether pharmacists are held to lower standards than others in medical fields, anything- ANYTHING- other than this mire of definition.
[Cheap shot written, considered, and deleted.]
Emotionally, I can argue that it wasn't murder for various reasons... Risk, intent, exposure, awareness of the crime by the victims and their families, fatality rates among the victims with or without the intervention of this particular pharmacist...
Legally, I would have to ask, in all seriousness: if this crime were committed _once_- if the pharmacist were caught with the first prescription shorted, even if the specific patient could be isolated- could you charge the man with murder?
If so, what's the murder weapon?
If not, can you think of any crime that becomes a different crime simply by repetition, before you get to the level of war crimes?
Or do we maybe need a new term to describe this kind of wrongdoing? Perhaps a new system of redress?
I suspect if he'd been caught after one count, he would have gotten a fine and a license revokation, possibly subject to review. _Maybe_ he would have done jail time. Not much comfort to his victim.
quote: And yet several people, including myself and Lyrnham, have given detailed reasons that specifically relate to the mindset involved here, including the particularities that arise from this man's profession.
I can find an isolated incident where Lyrnham explained how the phrarmacist's knowledge of his craft furthered his culpability by way of his understanding of the consequences of his actions. That's it; if you can show me otherwise, go for it. What I've been hoping for is more along the lines of "Why did he think he could get away with it? Why _did_ he get away with it for so long?" And, I suppose, more difficult questions about his training and any ethical component thereof, his relationship with the community, and so on. You might even go so far as to ask the extent to which "we" write off the elderly and those with a potentially terminal illness as less human. After all, companies are seeking the right to write off such people as of less worth for compensation in wrongful death suits anyway...
A significant portion of this discussion has been taken up by vitriol. I described the participants as a lynch mob, I feel it has influenced this discussion to its detriment, and I stand by that assertion. I don't think you're necessarily part of that, Dag, but if all you succeed in doing is nailing down the definition of this pharmacist as a murderer before moving on to the next horror of the week, what have you accomplished?
I'm not looking to play the martyr, I'm not demanding any apologies, and I'm damn sure not playing any games. If you have a particular point you'd like to address, or like me to address, illuminate.
Posted by erosomniac (Member # 6834) on :
This guy was clearly a terrible human being, but his crimes don't differ much from those that are committed by other people in the medical field every day: doctors who recommend courses of treatment that are far more expensive and require more visits than is necessary, obstetricians who diagnose the need for a c section when there isn't a need, etc. The only difference is that this pharmacist got caught.
Or you could go broader, and highlight the fact that this pharmacist was just symptomatic of the entire FDA: driven by money rather than by helping people. If the FDA were truly concerned with helping people rather than making money, we'd have a LOT more cures and far fewer treatments. How many different time increments of heartburn relief medication are we going to go through before we "magically" discover the cure for heartburn? How many addictive prescription sleep aids will be invented before a realistic cure for sleep is revealed? How many different, obnoxiously expensive HIV treatments will the government produce before they finally unveil the cure? Why is it that labs researching CURES for malignant conditions instead of treatments are threatened by the FDA?
Money. It's the bottom line. Welcome to America, the capitalist paradise. As long as money is the greatest of incentives for so many people, we'll continue to see things like this happen over and over again. I'm not trying to say it's not sad and morally reprehensible, I'm just not surprised at all.
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