Have you ever had surgery under general anesthesia? I have. In talking to many people who have had surgery “under general,” two thoughts always seem to come to mind. The first thought (or fear) is: will I wake up? Over time that fear has subsided. Anesthesiologists are extremely competent and well-trained. The techniques and drugs have come a very long way. But what about Medical Ethics?
The second fear runs much deeper. In “going under,” we are exposed; sometimes, literally as well as figuratively. We lose all control. We must rely on those in the operating room to protect us and treat us as they would like to be treated. It is complete trust that the person or people “working on us” will not demean us, abuse us or mock us, perhaps that’s where Medical Ethics comes into play.
Simon Bramhall and Medical Ethics
Dr. Simon Bramhall was a surgeon who worked at Queen Elizabeth Hospital in the U.K. British physicians and surgeons have an extremely high standard of care and training. Their skillset is certainly equal to any physicians and surgeons in North America.
It is not possible to understand Dr. Bramhall’s dark side in this discussion, but during two surgical procedures, 
This occurred in 2013.
The initials were made with a device called an argon beam coagulator. The coagulator stops the bleeding of blood vessels that must be cut during surgery. Apparently, and according to The Telegraph of London newspaper, the beams are not just for the control of hemorrhage but for appropriately marking the borders of the operating field.
This type of “branding” is appropriate, not harmful and over time disappear from the affected organ. Obviously, a procedure undertaken on a patient’s liver is a serious procedure. The patient’s life is in jeopardy and the patient is at the mercy of the surgeon.
In 2013, a patient’s liver was not healing properly after a procedure. It happens and surgeons had no choice but to go back into the site of the original procedure to make a correction. What they found was more than what they had anticipated. On the patient’s liver, the surgeon, Simon Bramhall, had carved his initials with the laser beam.
A full investigation was opened and it was found that Bramhall also carved his initials into the liver of a male patient. Bramhall was employed at Queen Elizabeth Hospital in Birmingham for 12 years. His specialty was liver, spleen and pancreatic surgery. There is no telling how many patients carried his initials over the years. Now anyone would know that such an action is clear violation of medical ethic.
Unlawful Force
The Birmingham prosecutor in this case, Tony Badenoch, has called the brandings “an intentional application of unlawful force to a patient while anesthetized.” He also said, “and an abuse of Bramhall’s power” He has also stated, “It was an abuse of the trust placed in him by the patients.” Bramhall admitted that he made “a mistake.” He is soon to be sentenced at the Birmingham Crown Court.
Though the “force” cited took advantage of a patient in a completely helpless state, it was more so an unethical abuse whose roots may run much deeper. For any unethical scandal to exist, there must be an opportunity, a need and rationalization. The rationalization on Bramhall’s part may have been that after a few months his clowning around with branding a patient’s internal organs would never be suspected as the scar (s) would disappear.
As far as opportunity is concerned, Bramhall had the power to exert control over patients who were utterly helpless. They couldn’t protest. Was it an act of hate on Bramhall’s part? Bias? Discrimination? We don’t know. That it was unnecessary and demeaning is a given. How many patients had he branded? We will never know.
However, I’d like to focus a bit more heavily on “need.” What was Bramhall’s need to play these games with the patient? We can think of “power” or even “anger,” but was it a motivation that was more edgy? Bramhall was hardly alone in the operating room theater. Who was with him? Who observed him?
As insane as this may sound, did he carve his initials into patients in order to impress a surgical intern or a nurse? Was he trying to demonstrate how clever he was? How sexy? How powerful? Then another serious question looms: why wasn’t this reported? Why did no one step forward? When considering issues of medical ethics it typically is about more than just one person.
Unless ethical behavior is not only taught, but reinforced, this type of behavior will always have a way of surfacing in different forms. This is a case that exceeds malpractice, it is the ultimate abuse of power.
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