Who should be a doctor?

What if your doctor was a convicted murderer?

In Sweden, there is a bizarre case involving a student admitted to one of the best medical schools in the country. He murdered a trade union worker and served six and a half years of an eleven-year sentence before being paroled.

The story gets even weirder.

He is currently attending his second medical school. He was kicked out of the first one for falsifying records.

The particularly liberal Swedish penal code aside – the country is committed to reintegrating its offenders back into normal society – the situation and subsequent uproar illustrates the set of assumptions we have regarding the kind of people that should be doctors.

The medical student’s classmates, who are divided on the subject, particularly emphasize this.

Most would refuse to be cared for by a doctor they knew was a convicted murderer. That makes sense. Committing a murder shows at best negligence, and at worst, sociopathic characteristics that would have significant meaning in a clinical setting.

Health care providers probably shouldn’t be licensed if they have murdered someone, or in similar situations involving things like violence and general disregard for others.
But what about smaller offenses and misdemeanors arising out of a momentary or atypical lapse of judgment?

I raise such questions because the debate between the two sides of the student body in Sweden revolves around subtle and problematic assumptions about who should and shouldn’t be a doctor.

They’re problematic because, in some cases, they have nothing to do with the qualities of good doctors and more to do with character judgments. These can be anything but objective.

Admittedly, it’s a blurry distinction, both from the perspective of medical schools and from the hospitals and institutions currently requiring background checks before students can begin work in a clinical setting. Both patient safety and health care workers’ civil rights are at stake.

Swedish universities are forbidden from conducting background checks of applicants, while here in the United States it depends on the institution. They screen for things like felonies, misdemeanors and dishonorable discharges from the armed forces.

In 2007, the Association of American Medical Colleges, responsible for administering the primary application to 130 accredited medical schools, implemented a pilot background check system in several selected schools. It hopes to make the service available to all medical schools in time for the class entering in 2010.

The medical licensing body in Sweden has come out and said that following graduation, the student in question will not be allowed to practice medicine.

Make no mistake about it, I agree with such a decision and question the wisdom of allowing a convicted murderer to matriculate.

But that’s where I stop, because background checks could go beyond felonies and introduce even more subjective standards for who can become a doctor.

At the very least, such checks should be insulated from actual admittance decisions.