Physicians are supposed to have a moral foundation to make judgements so that they do not harm patients. That is why isolated felonies such as drug abuse, consensual sex with patients or making a mistake will get you a reprimand and counseling, but repeat offenses–or serious crimes–will make you lose your license.

But the NYTimes has an article about Swedish medical schools debating the ethics of admitting an unrepentant murder who belonged to a Neo-Nazi group known for paranoid fantasies and violence.

The school couldn’t figure out how to expel him.

Luckily, they found out he had lied about his grades, so they finally were able to expell him.

The problem? Another medical school just admitted him to study to be a physician.

But the sign that some moral teaching is needed in Swedish medical schools comes from the “group interview” of medical students about the neo Nazi who committed a “hate crime” murder.

But Gustav Stalhammar, 25, said … “Who is to say that he might not become a great doctor, even if it in some ways would feel wrong or awkward to have a murderer for a colleague?” he asked. “It is not fair to have preconceptions about his character.”

Still, the five students said they were upset because they had not had a chance to meet Mr. Svensson and judge his motivations. And they are concerned that he has not publicly expressed regret for his crime.

What is missing from the discussion is an unwillingness to “judge” others, even in the face of horrific crimes.

Yes, we doctors have to take care of patients and treat them humanely, even when we disapprove of their behavior. But we also have to be able to judge if their behavior is dangerous, stupid, or evil–and often we are called to make such judgement calls: in prescribing narcotics, in doing job physicals, or in cases when we find suspicious problems in their partners or children.

The second case was a 24 year old medical student who raped a 14 year old boy when he slept. The original court sentenced him to 2 years in jail, but a higher court reduced the sentence to”… two years’ probation and medical therapy.”

When the dean at Lund sought to expel the student, a national board that reviews expulsions blocked the action, saying that although the man had committed a serious crime, he was not considered a threat to people or property. The decision was then reversed by an administrative court, which upheld the expulsion; the student did not appeal.

A pedophile who is not a threat to people and property? Sounds like how sexual offenses were treated in the US in 1970.

Well, if this was a one time deal it is quite possible that the man could be rehabilitated, but the dirty little secret is that too many such incidents are not isolated incidents, but the only incident where the perpetrator has been caught. And, as the Catholic church and many school districts have learned, too often these “nice” guys can manipulate the courts and counsellors as easily as their victims.

In both these cases, one can be sympathetic to students who have yet to experience the reality of good and evil, but one wonders why the administrators are so trained in political correctness that they no longer can recognize a pattern of behavior that suggests a con man at the best and a violent sociopath at the worst.

One should be able to recognize that serial offenses are not the same as an isolated lapse of a man of good character, but a sign of a serious psychiatric problem, anti social personality disorder, where a person literally either doesn’t know the difference between right and wrong, or knows the difference on a theoretical level, but figures they are exempt from the rules.

We used to call this type of person a “sociopath”.

And such a person shouldn’t get near a patient. Even if he goes into a “non-patient care” specialty, or research, the risk of falsification of data is too high.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket.

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