T. Harbin, Waking Up Blind: Lawsuits Over Eye Surgery (Minneapolis, MN, Langdon Street Press: 2009). *

How do ethics really work? How do people actually make ethical decisions? Tom Harbinճ book is a case study. It is the story of how the medical establishment of Emory University, my own university, covered up grossly unethical practices by one of its top physicians. It is also the story of the differing expressions of courage by the two men who brought this abuse to light. As such, it is a good study of how ethics work, not in the classroom or in books, but in the real world.

In 1976, the same year I arrived, Dr. Dwight Cavanagh was hired by Emory University to build the ophthalmology program. Dwight, whom I knew passingly, was known as a fine doctor and a great organizer, and he promptly set about building the Department of Ophthalmology with a large clinical base and considerable research. He also set about raising over $10 million dollars to build the Emory Eye Clinic. Before he left in 1987, he had succeeded in all these – a remarkable accomplishment.

In the early 1980s, his colleagues began to notice irregularities in Cavanaghճ practice of medicine: very quick diagnoses, inaccurate diagnoses, changing of numbers on charts, questionable billing practices, and a patient load that was too heavy for any reasonable doctor to bear. It was, however, an operation on the wrong eye, done late in the day, to a poor patient, and the subsequent doctoring of the records that set off alarms. As it turned out, it happened more than once that patients were operated on without proper attention being given to their glaucoma or other conditions, with the result that they actually lost vision in one eye or the other. And, it was often the poor (in the South, that meant mostly black) patients who were placed at the end of the operating day.

The lower medical staff went along with Dr. Cavanaghճ decisions, reasoning that he was the boss and he knew what he was doing. Eventually, Dr. David Campbell, who seems to have been motivated by a sincere Christian piety, and Dr. Allen Gammon, who seems to have been motivated by a sense of loyalty to the medical profession, began to raise questions. They talked to their colleagues, most of whom were more senior, and were met with evasions and outright hostility from almost all of these colleagues. They pressed for a Departmental Review that found and reported problems but the review did not evoke a response from the administration that would have called for a full and independent review. Then they pressed for a review by the Ethics Committee of the Medical School. This Committee exonerated Cavanagh and reprimanded David Campbell. Thus, rather than rise up in outrage, the medical establishment of Emory University became accomplices in the cover up.

A few patients were anonymously informed that their loss of vision was due to errors committed by Dr. Cavanagh and they decided to sue him and the faculty and physicians of the Emory Clinic and the Medical School. That development provoked a flurry of defensive activity by the University. It also prompted parallel investigations by the Georgia Composite Board of State Medical Examiners and the American Academy of Ophthalmology. The latter found serious faults in Cavanaghճ care for his patients. The suits and the investigations also provoked coverage in the Atlanta and national press which, in turn, provoked more defensive actions by the administration of the University.

Eventually, Cavanagh ҲesignedӠfrom Emory. Over the years, the wrong eye suit was settled for $4.2 million while the other settlements were settled out of court for undisclosed sums. Cavanagh and others went on to careers elsewhere and, at the time Harbin wrote his book, were serving in prominent positions in the medical world. Drs. Campbell and Gammon continued their careers. For Gammon, this meant continuing in non-academic medicine and, for Campbell, this meant severe curtailment of his distinguished research career. Both, but especially Campbell, were severely battered by the experience of being whistle-blowers in a profession that is very, very hierarchical and very, very self-protective.

The questions raised by this book are very important. They echo more general question of how and why ordinary people persuade themselves to do things that they know are wrong, while other ordinary people manifest courage in the face of steep social opposition and continue to advocate for truth and justice.

In my 1999 book, The Banality of Good and Evil: Moral Lessons from the Shoah and Jewish Tradition, I tried to confront these questions. The short answer is that hierarchies protect themselves by defining ҧoodӠas obedience. To be ҧoodӠis to stick together, to do what one is expected to do. The resolution to this dilemma, in short, is to build into the hierarchy an outlet, a method for accepting and seriously dealing with criticism of the hierarchy. In most organizations, this is the ombudsman. Had there had been an effective ombudsman at Emory when these events took place, someone who could be relied upon to conduct a full and independent investigation and publish its findings publicly, matters might have turned out differently. Such a procedure would have taken the process out of the hands of the Department of Ophthalmology and the medical and legal establishment of the University, whose role it is to defend, not to investigate. The characters would have remained the same. The arguments and counter-arguments would have been the same. But the process would have been more honest.

The question of why Campbell and Gammon resisted is also interesting. I do not know them, nor have I interviewed them, but I am willing to wager that both come from homes where childhood punishment was strict but fair. I would also wager that each had a person in his life who modeled behavior that resisted authority in the name of truth and justice. That is what the evidence shows, as I indicated in Banality.

Waking Up Blind: Lawsuits Over Eye Surgery is a very sad story – for the victims, for my University, and even for the heroes. But it is instructive, and Harbinճ narrative should give all who teach ethics and morality much pause to think.

* Appeared in Reviews in Religion and Theology, 19:4 (Sept. 2012) 460-63.