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Rights + Justice

A Combat Doctor's True Duty

Dr. Kevin Patterson was judged unethical for publishing a dying Canadian soldier's identity. Did he not serve a greater good?

Claude Adams 18 Feb

Claude Adams is a freelance journalist and videographer living in Surrey, B.C. He has worked in a number of international conflict zones.

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Dr. Kevin Patterson: Broke official silence.

Cpl. Kevin Megeney, a 25-year-old reservist from Stellarton, Nova Scotia, died two years ago, of a gunshot wound in the chest, in a medical tent at Kandahar Airport, in Afghanistan. More than 60 other Canadian servicemen have died in combat since then, but we still don't know the full circumstances of Cpl. Megeney's death.

We don't know why he died. But we know how, in a description of graphic, hair-raising, heart-stopping detail that evokes the fiction of Dalton Trumbo, or medical reports from U.S. Civil War battlefields. We know that his lungs bulged out of the chest incision, "inflating and deflating," and we know that litres of blood poured out of his chest wound in a "gelatinous heap." We know that Megeney had red hair and blue eyes and that he looked "cheerful even in death."

The Canadian surgeon who tried to save him called the Megeney shooting "another blue-on-blue" -- military jargon for "friendly fire," which is itself a distasteful jargon for the aberration of one soldier killing a comrade-in-arms, reasons unknown. (A court-martial is scheduled for this June.)

These observations into Cpl. Megeney's death appeared near the end of a 2007 article in the San Francisco-based magazine Mother Jones, an article written by Dr. Kevin Patterson of Saltspring Island, entitled "Talk to Me Like My Father: Frontline Medicine in Afghanistan."

The Canadian Forces make no apology for the fact that, two years after the corporal's death, we still don't know what prompted the shooting. Investigations into "friendly fire" incidents, it seems, unfold in extreme slow-motion, at a pace that seems designed to flatten adverse publicity. By comparison, the military inquiry into Dr. Patterson's act of non-fiction was nearly instantaneous.

'I will never reveal'

Before the end of October 2007, a so-called Summary Investigation found that Patterson had committed a "breach of patient confidentiality." A copy went to the BC College of Physicians and Surgeons, Patterson's professional regulating body.

And the college itself took more than a year before ruling that Patterson had indeed broken the doctor's code by naming the dead soldier. He was reprimanded, fined, and told to brush up on medical ethics. As part of the deal, Patterson apologized to the Megeney family, and confessed to having made a "bad decision."

Patterson was also put on a kind of creative probation: In any future writing, journalism or otherwise, he would not include the names of patients, or use information that could identify patients. (Interestingly, the deal says nothing about Patterson's freedom to divulge names, or details, with a patient's approval.)

Patterson gets little sympathy from fellow doctors, or from the arbiters of professional ethics. They all fall back on Hippocrates, the father of medicine, who said, "All that may come to my knowledge in the exercise of my profession... I will keep secret and will never reveal." I talked to several doctors and ethicists, and they all agreed that Patterson should not have used Megeney's name, or details that could have revealed his identity. Dr. Gabor Mate, a well-known commentator on social issues, said flatly that without doctor-patient confidentiality "there is no basis for a healing relationship." And bio-ethicist Dr. Margaret Somerville of McGill University had no time for the argument that the horrors of war need greater exposure. "The problem is, that's the argument that should have been put to the Megeney family (to get their permission) before the article was printed," Dr. Somerville said. "It's a valid argument but it definitely doesn't take precedence here."

What's the 'greater good'?

Stephen Ward, a professor of journalism ethics at the University of Wisconsin, in Madison, is not so sure. He said that telling the story of the death of Cpl. Megeney, in all its gore, may serve a "greater good" -- giving citizens needed insight into the "nitty-gritty" of the soldier's experience in wartime. "If the writing has anything to do with the pressures placed on the soldier," Ward said, "then it's good to know. We are too often accused of sanitizing war."

The "we" in Ward's quote, of course, are journalists, and Kevin Patterson is not a journalist. He is a civilian doctor who, in effect, keeps a journal, and shares this journal with his readers. (He is also an accomplished author of fiction and non-fiction.) Should he not, then, get a special dispensation from Hippocrates' inflexible rule of "Never tell?"

Patterson put forward this argument himself shortly after his article was published in 2007, as the controversy began to build. "It is necessary," he wrote, "to face with open eyes the grotesque nature of war trauma. The recent disengagement and fatigue of the public with these matters is itself grotesque." Who better to chronicle the "grotesque trauma" than the nurses and doctors who have to treat the wounded, often under extreme conditions? The military, sensitive to any news that may hurt recruiting, certainly won't tell these stories. And embedded journalists with the Canadian soldiers in Afghanistan are well aware of the price of breaking military rules about disclosure: you're on the next flight home."

Name of the deceased

Leaving Cpl. Megeney's name out of the Mother Jones article, of course, would not have protected his anonymity since Canadian newspaper readers already knew the soldier's name, and knew that he died from friendly fire. All that Patterson added to the story were the medical details of his final minutes of life.

Tom Maddix, an ethicist with Providence Health, said using Megeney's name was unnecessary. "Stories have great power," he said. "and the exact name of the person is not the issue." Professor Ward disagreed. He said using the name gave the story credibility and authority.

It's instructive that it was the Canadian Forces, and not Megeney's family, that provoked the investigation into Patterson's conduct. Mother Jones magazine contacted the soldier's family in Nova Scotia before the magazine hit the streets, to alert them to what was coming.

A military victory

Clara Jeffery, the Mother Jones editor, says she spoke with Karen Megeney, the soldier's mother, by phone. As she wrote in the magazine's blog, "She assured me that the family would like to see the article, and that she was a nurse and would read it before any other members of her family; she said it would help to have closure to know more about what happened. We heard from other members of the family who also wanted to read it, and some whom after they did expressed the desire to write to Dr. Patterson 'to express my appreciation to him for exhausting every effort to save [him]'."

It was only later, after the Canadian Forces completed their investigation, and the College of Physicians weighed in, that the Megeneys went public with their displeasure.

The Canadian military took an uncompromising zero-tolerance approach to Dr. Patterson, even though he was a civilian volunteer in a war zone. "The issue here is entirely about medical ethics, not military law or discipline," a Canadian Forces spokesman told me. Did the Megeney family bring an official complaint to the military about the Mother Jones article? "The family was not happy," is all the CF spokesman would say.

All arguments about the need for patient confidentiality aside, should the Canadian Forces be the sole judge of what information can and should be released about how soldiers live and die in foreign lands? Is there not a case to be made for the claim that the stories of the war dead belong to all of us since we have a moral, physical and spiritual investment in their sacrifice? Is it not arguable that, in some cases, their names and their violent stories should transcend our norms of "privacy?"

Is a policy of official silence not at least as grotesque as the stories of how soldiers die?

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