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The Conrad Murray Trial: Medicine, Money and Patient Care

Tanya Acker: At the end of the day it will be for the jury -- the one that sits in the actual courtroom -- to decide whether Murray's conduct was that of a solicitous personal physician or a fiscally driven reckless profiteer.

It is never easy to predict the twists and turns that the latest high-profile trial will take and Dr. Conrad Murray's involuntary manslaughter case is no different. But while the trial is sure to feature all the usual bells and whistles that attend these excursions into celebrity justice, when it comes to one staple of these affairs -- the revelation of salacious new details about the troubles of a fallen icon -- its offerings may be limited.

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The judge in the case already has ruled that discussion of the Michael Jackson molestation trial is off limits (thereby ensuring that we won't have to relive the trip through that particular rabbit hole) and also has excluded a variety of other evidence about Jackson's allegedly fragile state. The garden from which the digging up of dirt may be done now has a fence around it; how securely that fence may guard against trespassers, of course, is an entirely different story.

What the trial certainly will contain, however, is a high-profile exploration of what we -- celebrities and "normals" alike -- expect from the people who care for us; and as the 32-page questionnaire issued to jurors suggests, the lawyers in this case seem to be particularly interested in whether those expectations shift depending upon which category (celebrity or regular folk) the patient falls.

Among other topics, the questionnaire asked jurors whether they thought celebrities received special treatment and whether a doctor ever had refused to prescribe medication that they specifically had requested. While most of us with access to medical care never will face the dilemma of whether we are asking "too much" of our $150,000 per month doctors, the issue of whether money buys new rules is as pertinent to medical treatment as it is to other areas of American life where its ability to change the game is firmly established. Indeed, in an era of Internet-fueled self-diagnoses, where well-heeled patients (sometimes armed with information of questionable legitimacy) may stubbornly insist upon particular therapies, doctors have a greater responsibility than ever to serve as a bulwark between the curative and the dangerous.

The issue of Murray's guilt or innocence will turn on a few discrete questions: Did the doctor fail to perform a legal duty that he owed to Jackson? If so, was his failure so reckless as to create a high risk of death or great bodily injury? Would a reasonable person have known that acting in such a way would have created the risk it did? Did that risky conduct cause Jackson's death?

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Already the defense has raised questions surrounding Jackson's use of other drugs, arguing that it was Jackson's alleged self-medicating and addiction to other drugs, rather than Murray's conduct, that resulted in the music legend's demise. (One of the pretrial battles involved the defense's access to medical records held by longtime Jackson dermatologist, Dr. Arnold Klein, who allegedly injected Jackson with Demerol 51 times over 3 months. The Murray team won that round, gaining access to a certain number of the records.)

This narrative, however, proves only so much: Dr. Murray was just that -- a doctor, so pointing the finger at a patient's other alleged bad habits will not suffice as an excuse for allegedly mismanaged care. Indeed, it is precisely because of a patient's vulnerabilities, physical and otherwise, that we expect physicians to adhere to objectively reasonable standards in treating them: jurors in the court of public opinion may have an even shorter fuse for the alleged practice of "celebrity medicine," in which one might purchase his way around those standards, than they do for the "celebrity justice" that seems regularly to cut big breaks to stars in distress.

But proving that this case involves such "celebrity doctoring" is the state's burden to carry. Expect Murray's team to tell the story of a physician dedicated to a patient in such distress that only the most extraordinary therapies could serve to treat him. They will urge jurors not to play the "20/20-hindsight" game -- arguing that Dr. Murray did the best he could for a demanding patient whose self-destructiveness ultimately would overwhelm the efforts of even the most attentive physician.

At the end of the day it will be for the jury -- the one that sits in the actual courtroom -- to decide whether Murray's conduct was that of a solicitous personal physician or a fiscally driven reckless profiteer. The rest of us will simply be left to consider whether that slope really is as slippery as some say.

tanya acker

Tanya Acker

Republished from Huffington Post with the author's permission.