Earlier this week, the Tokyo District Court acquitted Dr. Takeshi Abe, the former Teikyo University vice president charged with professional negligence resulting in the death of a hemophiliac. The decision reveals the difficulty in passing legal judgment on medical acts by a doctor, in which effects and risks of treatment are two sides of the same coin. The not-guilty ruling also brings home the fact that a doctor’s moral and social responsibilities are different from his or her legal responsibility.
In essence, the ruling said: In 1985, when Dr. Abe’s subordinate at Teikyo University Hospital administered imported unheated blood coagulants to a patient under his orders, a majority of hospitals here were using the same products. Under the circumstances, most hemophilia specialists would not withhold their use. Therefore, Dr. Abe’s continued use of the products does not mean he was negligent.
The trial turned on two critical questions. The first was whether Dr. Abe was aware of risks that the medications caused death from AIDS. The ruling, based on a detailed analysis of reports from virus researchers abroad, said the possibility of his anticipating the risk was “low.”
Looking back, AIDS research here was at a delicate stage in May and June 1985 when unheated blood coagulants were being used. This fact seems to have affected the ruling. If the blood products had been administered in or before 1984, the risk of death would have been unclear. But after 1986, the risk of HIV contamination would have been considerably higher, and Dr. Abe could have been held responsible.
But at the time, Dr. Abe was a leading authority on the treatment of hemophiliacs. He served, among other posts, as head of a research team set up by the Health and Welfare Ministry. He was also able to obtain up-to-date information from abroad. If he had made the best judgment at the time, the number of victims of tainted blood products — the Teikyo Hospital patient who died was one of them — could have been reduced.
The plaintiffs take the position that the deaths resulted from “compound negligence” on the part of drug makers, the health ministry and the doctors involved. Medical personnel should give top priority to patients, putting them above even their own interests. They should reflect seriously on this unfortunate incident and step up joint efforts to root out AIDS.
Prosecutors maintained that Dr. Abe ordered his subordinate to administer unheated coagulants to the patient from May to June 1985 and that the medications caused his death from AIDS. In the larger tainted-blood scandal in which hemophiliacs were involved, more than 1,400 patients became infected with HIV and about 500 of them died of AIDS. Prosecutors focused on the Abe case as a typical example of the abuse of drugs in an effort to pursue Dr. Abe’s legal responsibility. However, defense attorneys called this a witch hunt.
It should be noted that the ruling is based not on an evaluation of the facts as viewed from the present perspective, but on the medical standards of 1985, when the relationship between AIDS and unheated blood products was not yet established.
Furthermore, in determining whether Dr. Abe was negligent, the district court considered whether his judgment was similar to that of most specialists in hemophilia in the same circumstances — not the highly advanced judgment that an authority on hemophilia should have made in that critical period. This is a realistic view, but one that could cause controversy.
The other question at stake was whether Dr. Abe should have used safer medications, such as domestic products, in place of imported unheated products. In other words, the question was whether he had an obligation to anticipate consequences. On this point the ruling said Dr. Abe did not have such an obligation because the methods of treatment being used at the time were “fluid and confused.”
The ruling did not clear Dr. Abe of all blame. It cast doubts over some aspects of his conduct, saying, “It seems likely to outsiders that he was trying to display his authority and that he was considering ways to protect his prestige.”
In fact, there is something shady about the whole episode. Dr. Abe received financial support from drug companies. The former Green Cross company continued selling unheated blood products in order to reduce its stocks. The health ministry delayed a decision to change the prevailing treatment method. All these seem to be intertwined.
The ruling has come as a shock to the patients and bereaved families concerned. The ruling, however, says it is “significant to further examine the facts from various angles” in order to improve medical treatment. The “not guilty” verdict does not mean that Dr. Abe has been cleared of all responsibility.
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