Better in their words…

If we took seriously the proposals of Dr. Caplan, it would mean we should respond to the heinous actions directed by Putin and the Kremlin with attacks on average Russian citizens— patients and doctors— many of whom may oppose their own government’s actions, some of whom are protesting those actions, and all of whom are currently subject to authoritarian rule. As a practicing oncologist, the thought that we would take away Russian cancer’s patients access to medications— including curative ones— to punish Putin frightens and sickens me.

Dr. Caplan’s argument.

In an essay entitled, Pharma Should Stop Doing Business in Russia, Says Ethicist, Dr. Caplan argues the following.

How far does noncooperation with Russia go? Very, very far. All research, both ongoing and new, must cease immediately. Whatever can be done to minimize harm to existing subjects in a short period of time ought to be done, but that is it.

Similarly, no sale of medicines or therapies ought to be occurring, be they life-saving or consumer products. Putin will see to it that such shipments go to the military or are sold on the black market for revenue, and there is nothing pharma companies can do to stop that.

The Russian people need to be pinched not only by the loss of cheeseburgers and boutique coffee but by products they use to maintain their well-being. War is cruel that way, but if you tolerate a government that is bombing and shelling a peaceful neighbor to oblivion, then pharma must ensure that efforts to make Putin and his kleptocratic goons feel the wrath of their fellow citizens.

Of course what this practically means is that a 48 year old woman in Russia with a diagnosis of DLBCL— a curable cancer— will no longer get R-CHOP therapy and may likely instead die a painful and avertable death. A 24 year old man with testicle cancer may be deprived of BEP and die in a cruel way we have not seen since the 1950s. Older people who depend of life prolonging medications will be without them, some may have malignant hypertension, heart attacks, strokes or worse.

Dr. Caplan’s proposal is to withhold medicine as a tool of war. And this war is war directed at civilians, and not military forces. It is precisely what we condemn Putin for, and yet Dr. Caplan advocates we retaliate with this measure? The UN explicitly defines this as war crime:

Intentionally directing attacks against the civilian population as such or against individual civilians not taking direct part in hostilities;

In a second piece on scientists, Dr. Caplan discusses a proposal to ban Russian scientists from academic societies, and to no longer accept their papers. He acknowledges that many scientists may themselves be innocent of the actions of their government, they may oppose them, even. Caplan says, paraphrasing his critics:

“Why are we punishing Russian and Belarussian cardiologists, acting as if somehow they are responsible for what the Russian army is doing or for what Putin has decided to do? Why are we acting against them? They are just trying to fight heart disease. That’s a legitimate goal for any doctor, public health official, or scientist.”

He then answers his own question

The reason to break the ties is that that is the way to bring pressure upon Putin and his kleptocratic, oligarchic advisers to stop the attack, to try and bring down their economy, to say, “Business is not going to go on as usual. You will be excluded from normal scientific and medical commerce. We’re not going to be holding conferences or exchanging ideas,” and in my view, extending it to say, “We’re not taking your papers, we’re not publishing anything you do. We’re not even having you speak at our meetings until this war, this aggressive invasion, and these war crimes come to a halt.”

I find it troubling that an ethicist would decide to weaponize scientific societies, scientific publishing, and worst of all withhold medications from average citizens because he believes this may indirectly put pressure on Putin. The argument itself is unsound. Russia is not a democracy, so it’s not obvious why we would expect that punishing the masses/doctors would put “pressure on Putin.” Horrible deprivation in Venezuela has done nothing to bring down the Maduro government, another autocratic regime, for example. Dr. Caplan is willing to hurt Russian civilians but no one knows if that will pressure the Kremlin.

We are entering a dark place where ethicists promote unethical actions— actions that run counter to the universal oath of physicians. I worry that Art Caplan is suffering from hubris— a dangerous arrogance that he can solve global conflicts, and I worry most about the lengths he is willing to go.

* I would have preferred to not engage with Dr Caplan, since he had previously mischaracterized my work, and made no attempt to correct it, even after this was pointed out to him by colleague.

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