Medical Ethics in Consultations: The Case of Elián González

Author: 
Lydia M. Usategui, MD
Article Type: 
Commentary
Issue: 
September/October 2000
Volume Number: 
5
Issue Number: 
5

By now, most people are aware of the tragedy involving Elián González, the six-year-old Cuban boy who was found floating in an inner tube off Hollywood, Florida, on Thanksgiving Day, 1999. Elián had left Cuba on November 22 on a small boat in the company of his mother, common-law stepfather, and a group of eleven others in search of freedom. The group encountered mechanical difficulty during the crossing and all but three in the group drowned, including Elián's mother. Elián was taken to a hospital following his rescue. Lázaro González, Elián's great-uncle, went to pick up Elián from the hospital with the explicit consent of Juan Miguel González, Elián's father, who had remained in Cuba.

The Miami family, in observance of the expressed wishes of Elián's mother, Elizabet Brotons, requested that Elián be allowed to remain in the U.S. with the expectation that his father would join him later, as has been the case of most refugee family situations fleeing Cuba. The father later changed his position and began requesting Elián be returned to Cuba. The case initially was assigned to the family court system in Florida. Then, a few days later, the Immigration and Naturalization Service (INS) reversed itself, and the custody dispute took on a political tone.

In custody disputes, it is customary to perform a thorough evaluation of both adults and children, including interview, observation of parent-child interaction, and consideration of testing. Cases for complete evaluation should be accepted only if the evaluator is court-appointed or agreed on by both parties. The professional should conduct the evaluation as a neutral, impartial advocate for the best interest of the child, which also has the benefit of maximizing credibility with the courts. If the evaluator has seen only one parent, opinions should not be given on ultimate custody. It also may be critical for the evaluator to talk with consent to the child's therapist.

The above was far from what transpired in the case of Elián. The government appointed a group of professionals: two psychiatrists, one psychologist, and a pediatrician as "consultants" to make recommendations regarding resolution of this family conflict. This group of professionals proceeded to make recommendations to the government regarding the transfer of custody for Elián without following the established guidelines for custody issues. They did not meet Elián, the patient, prior to making recommendations for his care. They did not evaluate the family, child-guardian relationship, environment, review results of testing or speak with the treating therapist. Instead, they seemed comfortable making recommendations based on TV reports and other media-disseminated information and data provided by the agency contracting them (i.e., which had already made a determination on what it wanted to do in this case).

In the "Principles of Medical Ethics" of the American Psychiatric Association (APA) there is a specific clause: "It is unethical for a psychiatrist to offer a professional opinion about the specific individual, unless he or she has conducted an examination and has been granted proper authorization for such statement."

In the case of Elián González, this was not done. Yet the professionals contracted by the government proceeded to make very damaging statements about the Miami family, the home environment, and, about Elián, certainly without the Miami family's consent.

In any consultation, it is common practice to contact the prior treating professional with the appropriate consent for obtaining additional history, and thus assuring continuity of care. The government-hired professionals, not only did not do this before making their recommendations, but subsequent to the raid also have failed to do so.

It is important to note that their long-distance evaluation without meeting the "patient" (Elián) became the justification for the government's violent, traumatic seizure of this child from his Miami home.

Following the raid, the government-hired professionals made public statements minimizing the level of trauma the raid entailed for this child, thus redefining the psychiatric condition of Posttraumatic Stress Disorder. They continued to make recommendations without observing Elián in the presence of significant others (i.e., determined to be significant by U.S. licensed professionals previously treating and evaluating him).

They made statements in public about the mental status of Marisleysis (Elián's cousin), as well as made recommendations for her, without ever meeting her. They even recommended that Elián not see his Miami relatives at this time, again without the necessary ongoing evaluation of this situation. It seems basic to allow a child to see the family he lived with at a critical time in his life, whom he came to love, and whom he last saw with submachine guns pointed at them (including a cousin of the same age). Elián was not even allowed to speak on the phone with his Miami family at the recommendation of the government-hired professionals. This raises the question whether this was an effort to weaken his bond with his Miami family in the service of the pending unresolved legal issues.

All of the above leaves us with serious concerns regarding the misuse of the medical profession for the service of a given agenda.

I was one of the mental health professionals who was outside the home of Elián González on the day of the raid, April 22, 2000. I was there of my own volition without monetary or any type of remuneration. I wanted only to be a witness to what was about to happen - what I expected to be a peaceful transfer of custody, never expecting a violent event. When the federal agents arrived, I was on the back porch, and I was one of the people who had a submachine gun pointed at them. We were then sprayed with pepper gas as they left. I was not informed that the agents holding these weapons did not have their finger on the trigger. I was told to get down, look down, and not move - left with the frightening thought that I could be shot if I made the slightest movement. Why? So that I could not do what I was there to do: witness the violent seizure of a six-year-old boy at gunpoint from his family in the wee hours of the morning.

Dr. Usategui is a psychiatrist practicing in Miami since 1986.

Originally published in the Medical Sentinel 2000:5(5):175-176. Copyright © 2000 Association of American Physicians and Surgeons (AAPS)

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