Homicide Committed by a Physician: Benefits of Boundaries in Professional Relationships

As I read the details of Michael Jackson’s death and relationship with his personal physician, I am surprised at how wrong this situation went ( Moore, S. (August 28, 2009). Jackson's death ruled a homicide. New York Times. see below). Then again, I am not that surprised. I think there is good reason that practitioners do not live with and become a part of the family of their patients. It is similar to why a practitioner cannot appropriately care for a family member. I admit I do smile to imagine what that lifestyle might be like, to live in the midst of such fame and fortune. It is incredibly appealing. It is easy to see why his physician chose to put himself in that situation.

Better however is the typical situation, where the structure of one’s practice aids the provider in maintaining some objectivity in judgment related to working with individuals with complex and difficult to treat problems. Better with a drug seeking patient, to only have to respond during the professional appointment time to the request for drugs vs. a 24/7 requirement to interact with your patient. Better with a drug seeking patient to have colleagues to discuss the case with when you are managing the complex problems arising in treatment.

How poorly managed Michael Jackson’s problems were. It seems fame and fortune do buy one the ability to deny problems and to purchase the kind of care one wants despite whether that care provides any real benefit. Yes, I am referring to his medication management and the multiple surgeries to change his looks, and I imagine fix the problems perhaps from the last surgery. Amazing that things could go so wrong.

Jackson received ativan (lorazepam), valium (diazepam) and versed (midazolam) within six hours of his death, along with the propofol which of course then rendered him unconscious as would be expected with an anesthetic, and the combination packing a strong wallop of respiratory depression from the combined effects of all of the drugs (with half life ranging from 1 to 4 hours for versed to 14 to 70 hours for valium). Of course we have no knowledge of the timing and doses involved, and I can only imagine the tolerance that was present.

We are taught some basic principles in developing a professional relationship with a patient. We maintain a particular role in that relationship. A role that would be difficult to maintain in a 24/7 relationship. Particularly if the patient is drug dependent and in denial about that. Imagine being begged to provide drugs to aid in sleep. I imagine the import of having his own live-in personal physician was to help Jackson be able to perform in this upcoming tour. So here is a practitioner faced with that very agreement: you pay me tons of money to live with you and be your personal physician, and I will treat your needs so that you can continue your career. That is a tremendous burden for an individual provider to take on. Particularly alone… In the middle of the night… and into the day… with a patient begging for drugs.

The boundaries we are taught in maintaining a professional relationship are helpful. Particularly in complex situations… With difficult patients... With patients we care about, and maybe have difficulty maintaining objectivity... With patients who are lavish in their spending for your services and for your presence. It seems the sweet deal Dr. Murray had with Jackson was not so sweet after all. There is good reason to rely upon the professional roles, structures and boundaries that protect not only us, but even more important our patients.

Moore, S. (August 28, 2009). Jackson's death ruled a homicide. New York Times. link: http://www.nytimes.com/2009/08/29/us/29jackson.html?scp=17&sq=michael%20jackson&st=cse