A leader's health is the public's concern

Doctors at a recent ethics conference tried to determine how much privacy leaders should be allowed when it comes to their medical files.

sharon report 298 (photo credit: Avi Hayun)
sharon report 298
(photo credit: Avi Hayun)
If you felt sorry for Hadassah Medical Organization director-general Prof. Shlomo Mor-Yosef having to give regular reports on Ariel Sharon's medical condition (including his urine production) after his second stroke, think about the author of the first four verses of the Bible's first Book of Kings: "Now King David was old and stricken in years; and they covered him with clothes, but he could get no heat. Wherefore his servants said unto him: 'Let there be sought for my lord the king a young virgin; and let her stand before the king and be a companion unto him; and let her lie in thy bosom, that my lord the king may get heat.' So they sought for a fair damsel throughout all the borders of Israel, and found Abishag the Shunammite, and brought her to the king. And the damsel was very fair; and she became a companion unto the king, and ministered to him; but the king knew her not." Not only was the 70-year-old king of Israel described as being so cold in his palace that he needed a human "heater" to keep him warm, but he was also impotent despite having the beautiful Abishag in his bed. This description - among the earliest official "medical reports" on the health of a leader - was intentionally worded to make David look pathetic, maintains Israeli author and biblical literary expert Meir Shalev. Speaking at the Jerusalem Ethics Center's symposium on "Truth and Lies on Leaders' Health" earlier this month, Shalev insisted that King David was being punished at the end of his days for his moral lapses, especially for sending Uriah the Hittite - the husband of Bathsheba and a soldier in his army - to his death after the king's affair with her produced a pregnancy. "David's physical and cognitive health was lacking, but his moral health started to decline early. His old age was ignominious," said Shalev, who once worked in Jerusalem as a Magen David Adom ambulance driver. "If there had been journalists at that time, no one would have the audacity to write this." THE FASCINATING five-hour symposium in the capital's Yemin Moshe quarter was obviously inspired by the controversy over Sharon's treatment at Hadassah University Medical Center and efforts by his personal staff and family to put a positive "spin" on his condition, especially after his first - minor - stroke. But the discussion also delved into other issues, including the need for laws requiring full medical disclosures by leaders and candidates for high offices; the relationship between politicians and the media, the "red lines" that the media decide not to cross, and the diagnosis of world leaders' health by "remote control" intelligence. Prof. Yoel Donchin, a senior Hadassah anesthesiologist whose hobby is watching and analyzing movies, presented clips from numerous films about historical characters from Caligula to Franklin Delano Roosevelt. Prof. Avi Reches, head of medical ethics at the center, a senior neurologist at Hadassah University Medical Center in Ein Kerem and head of the Israel Medical Association (IMA) ethics bureau, uncovered a note produced by the Tel Aviv Municipality about Mayor Meir Dizengoff in 1935. The mayor developed "high fever and complications. We hope he will overcome it." At the bottom was a warning: "Do not inform the press!" But he wasn't the only senior leader whose health situation was kept under wraps, said Reches. Thenprime minister Golda Meir suffered for years from a blood cancer and used to sneak into Hadassah after dark for chemotherapy. Reches, a student, remembered that he had to take blood from her, "and she - who was listed in the records as 'Zehava Gold' - had no [visible] veins." Then there was, of course, Menachem Begin, whose health during his two terms as prime minister has been the subject of numerous articles and books and was discussed later during the symposium. Reches noted that many American leaders hid their medical conditions: Woodrow Wilson's wife was de facto president for months after he had a stroke. FDR's blood pressure was 260/150 when he appeared with Churchill and Stalin at Yalta after the end of World War II, and as a result of his impaired functioning, "Stalin outsmarted him" to control Eastern Europe. At a White House meeting attended by Israelis, Ronald Reagan - who died much later of Alzheimer's - spoke using index cards, Reches said, "and when they suddenly fell on the floor, he tried fruitlessly to put them back in order. He didn't know what he was saying." THE PUBLIC'S curiosity about their leaders' health "knows no bounds, and the media will always run after them. In recent years," Reches added, "the private lives of leaders have turned transparent." The Hadassah neurologist, who declared that he was not involved in Sharon's treatment, presented on the screen a series of articles on Sharon, most of them using anonymous "medical sources" and published in Ha'aretz. The articles claimed Hadassah gave him treatment "unsuited to" the cerebral amyloid angiopathy (a disorder in which protein fibers infiltrate the blood vessels in the brain and make them fragile and at risk of hemorrhaging) he was found to suffer from. Ha'aretz claimed the "cocktail" of anti-clotting drugs Sharon was given to prevent a second ischemic stroke caused his catastrophic hemorrhagic stroke. Reches complained that the media presented commentary from non-Hadassah doctors who had no inside information on Sharon's medical file, and that many were "wise after the fact." He added that his doctors told the prime minister to rest before his scheduled (but never performed) surgery to seal a congenital hole in his heart, but that he didn't listen. Sharon's complicated condition was a "no-win situation" in which doctors "had to choose between two evils in an effort to prevent a second stroke." The IMA's ethics bureau is currently discussing the issue on leaders' health, right to privacy and transparency, Reches said. So far, there is agreement that a patient's personal physician must not decide whether the leader is able to continue in office; instead, other physicians should be drafted by a state apparatus." Leaders and candidates for high office should be required by law to provide ongoing reports on their health, he said, and a Likud-sponsored bill to do just that has passed its first reading in the Knesset. Dr. Ofer Grozbard, a clinical psychologist at the National Security College's Center for Strategic and Policy Research, lectured on the thesis of his recently published book - that Menachem Begin suffered for decades from bipolar disorder (manic depression) and that his deteriorating condition during the Lebanon War was hidden by his close associates. Then Cabinet secretary Dan Meridor "has kept quiet for 24 years" about Begin's inability to function, the psychologist charged. Although the Begin family has claimed privately that Grozbard's research is motivated by the hope for book sales, the researcher said he was allowed access to documents at the Begin Heritage Center, but that after his book was published and Ha'aretz published a magazine article on it, the center became hostile to him. Hadassah Medical Organization chief Mor-Yosef, a mild-mannered gynecologist who claimed Landau failed to respond to his messages of protest about his paper's coverage of Sharon's treatment, declined to shake hands with the Ha'aretz editor. "Six months have passed [since Sharon's hospitalization], but that is still not enough time to give it enough perspective... I don't want to argue with anybody. There is no confrontation between Hadassah and Ha'aretz, but there are lessons relating to medicine, politics and the media and the way information is transmitted to the public. The then-prime minister's hospitalization was a dramatic event that the world watched... Maybe we didn't say enough. I don't say we were perfect. There were dramatic decisions taken under pressure with 400 journalists camped in the hospital courtyard," said Mor-Yosef. "They came from all over the world... to cover the funeral of a prime minister. But he was alive... And now, six months later, experts in all fields admit that the treatment he received was the accepted course. Sadly, we can't say it was successful because he is still unconscious. There is no solution to every medical problem. Medicine is full of alternatives and decisions. A correct decision could have a bad result and vice versa." THE HADASSAH director-general did not attend the controversial press conference organized by the Prime Minister's Office after Sharon's first stroke, to which only political and diplomatic correspondents - and not health reporters - were invited. Mor-Yosef implied that much of the controversy and confusion about what Sharon's doctors said was due to the journalists' lack of expertise rather than any attempt by Hadassah physicians to mislead. Landau, in his speech, disclosed that after his paper's hammering away at Hadassah for some time, he gave an order to "reduce the dosage" of coverage, as deputy prime minister Ehud Olmert had taken over and Sharon was no longer in charge. But the same day that his editorial announcing this new policy appeared, a Ha'aretz reporter learned of Sharon's amyloid angiopathy, so the story appeared - under a different reporter's byline to protect sources - on the front page. "I had to publish it; it demanded to be published!" Landau asserted. But Mor-Yosef denied that Hadassah doctors did not know of the condition and that this alleged ignorance resulted in the second stroke. The doctors knew, said Mor-Yosef, but taking everything into consideration, the treatment given was judged the best. Dr. Yuval Karnieli, an academic lawyer active in the Movement for Freedom of Information, maintained that the lack of information to the public and doctors may have harmed the quality of treatment Sharon was given, and the law must be changed. "The Sharon affair blurred the borders, with some doctors working like media people and some journalists acting like doctors and explaining things they didn't understand," he said.