The conclusion of homicide was based partly or wholly on the confirmation of the medication propofol in Mr. Jackson's system at the time of his death. Propofol is an anesthetic agent administered intravenously, the only approved use of which is inducing and maintaining an unconscious state in intubated (i.e., placed temporarily on a respirator) patients undergoing medical procedures such as surgery.
So, at first blush, use of propofol as a sleep aid is not simply creative—it is clearly inappropriate and out of bounds. A responsible medical practitioner shouldn't do such a thing. In Mr. Jackson's case, propofol use was compounded by the use of benzodiazepine sedatives, including Valium and Ativan, habit-forming and potentially dangerous drugs in their own right. These, at least, however, are legitimately used in the out-patient setting as a matter of routine. In light of the irresponsible and dangerous administration of drugs he oversaw, Dr. Murray is easily cast as the villain here. And, indeed, there is a good chance he will be prosecuted. But I think we should be cautious about a rush to judgment. Here’s why:
Between any doctor and patient there is something of a pact, an implicit if not explicit agreement to respect the relationship and make it work. The patient, ultimately, is the boss—deciding when he or she is satisfied, what he or she is willing to do, what he or she needs. But the patient should respect the doctor's role, which is all about expertise. A patient's requests and demands should be tempered by a doctor's advice. Otherwise, the pact breaks down, and the relationship ceases to work in the patient's best interest.
Maintaining this effective interaction can be challenging under ordinary circumstances—and let's face it—taking care of Michael Jackson must have been anything but ordinary. Mr. Jackson's idiosyncrasies, iconic status as one of the world's best-known celebrities, and rather bizarre medical history all suggest he was likely a very atypical patient, requiring atypical care. For the moment, let's assume that Mr. Jackson found ordinary sleep aids insufficient, and demanded something more. Any doctor caring for him would presumably know that what Michael Jackson wants, Michael Jackson gets—if not here, then elsewhere.
While I have never done anything nearly so off-the-reservation as administering propofol for insomnia, I have—many times—given in to patient demands and done things about which I felt ambivalence at best. My job is always to find a way to help my patients, and sometimes none of the options left is all that terrific. There have been times I felt: better to try something a little uncomfortable than hit the wall now, and lose this relationship altogether. No one likes to fail in the mission to which they have dedicated their lives.
Did Dr. Murray callously prescribe potentially lethal medication to Mr. Jackson with wanton disregard for the potential consequences? Did he reluctantly, resistantly, and incrementally yield to Mr. Jackson's insistence? Or was it something in between?
Documentation emerging from the on-going investigation certainly does not suggest indifference or neglect by Dr. Murray. In fact, he apparently was at Mr. Jackson's bedside throughout the night prior to the star's death, administering medication and monitoring the effects. On the one hand, this places Dr. Murray at the “scene of the crime,' as it were, and figures in his implication. On the other, what was in it for him, other than a sleepless night? Continuous treatment of insomnia from 1AM to 10AM does not sound like fun, and is certainly beyond the call of routine medical duty. Perhaps this is the level of devotion required to be Michael Jackson's doctor.Certainly, there is no suggestion that Mr. Jackson's death was anyone's intention. And I suspect if Dr. Murray did not acquiesce to Mr. Jackson's requests, someone else would have become Mr. Jackson's personal physician.
Some of this tale is unique to the world of high-profile, high-powered celebrity. But some is not. Here are the implications for the rest of us:
1. It takes two to tango. The doctor-patient relationship is just that—a relationship. It works only as well as the interaction. The best analogy may be an athlete and coach. The coach coaches, but the athlete decides what he or she is willing to do. Mutual respect, mutual trust, and mutual effort are crucial for success.
15 ways to have a better relationship with your doc
2) You can't always get what you want. But you just may find, to quote Jagger, you get what you need. As a patient, find a doctor you can trust—and then do just that. If you want “more,” ask for it—but don't assume that everything you think you want is a good idea. Propofol-induced sleep may sound tempting, but it's a bad idea if the chances are high that sleep will be permanent rather than temporary! Doctors will sometimes have to say “no” not because they don't want to help, but because they do.
Are you taking the wrong med? (Up to 50% of patients may be!)
3) Stay the course. There are many reasons why medical care might run off the rails, but a common one is doctor shopping: Patients who keep looking for a doctor who will do what they want. I advise against this. Instead, find a doctor whose knowledge, compassion, commitment and judgment you value—then stay the course. If that doctor won't give in to what you want, it's probably for good reason. And finding one who will may be a bad idea. Even ... lethal.
What everyone should know about second opinions
4) Balance the power. When you seek medical care, it is about you, your body, your life. So you should be the boss. But. Your doctor has years of training, and rarefied knowledge and expertise you lack. And visiting Wikipedia or searching the Internet for an hour does not make up the gap! As the saying goes, a little knowledge is a dangerous thing! Doctors must respect their patient's autonomy, and final authority over their choices. Patients must respect their doctors' expertise, and show some humility. I can't know, of course, but I suspect this pact broke down in the care of Mr. Jackson.
4 times you should never self-diagnose
More Smart Advice on Staying Healthy
14 health mistakes even smart women make
Tired all the time? 7 signs it’s something serious
5 vitamins you’re not taking, but should be
