兩周前，特朗普的前主治醫(yī)生哈羅德·伯恩斯坦恩在接受CNN采訪時爆出猛料，稱其2016年大選期間為特朗普開出的健康證明完全是由特朗普口述的。他表示：“整封信都是由他口述的，不是我寫的。后來我只得配合他們演戲?！本痛耍绹恢t(yī)療道德專家對《財富》表示，如果此事是真的，再考慮到伯恩斯坦恩曾經(jīng)泄露過特朗普偷偷吃生發(fā)藥的事，他很有可能遭遇法律和倫理的雙重審查，其行醫(yī)執(zhí)照“絕對應(yīng)該被吊銷”。

伯恩斯坦恩則表示，2017年2月，他在接受《泰晤士報》采訪時泄露了特朗普吃藥生發(fā)的小道消息后不久，他就遭到了白宮人員的一次“突然襲擊”，這也標志著他與特朗普的關(guān)系徹底決裂。2016年，伯恩斯坦恩曾給特朗普開出了一份略顯夸張的健康證明，稱特朗普是美國有史以來“最健康的候選人”，他的體檢結(jié)果“令人驚訝地好”。這些話雖然極像特朗普本人的用詞，但確實打消了不少人對老人執(zhí)政的擔(dān)憂。

此前伯恩斯坦恩一直表示，這份診斷證明是由他“親自”主筆的，但現(xiàn)在他的態(tài)度卻來了一百八十度大轉(zhuǎn)彎。美國著名生物倫理專家、紐約大學(xué)蘭貢醫(yī)學(xué)中心醫(yī)療倫理部主任亞瑟·卡普蘭醫(yī)生認為，伯恩斯坦恩很可能會因此事受到紐約醫(yī)學(xué)委員會的責(zé)難。

卡普倫在接受《財富》采訪時表示：“伯恩斯坦恩的行醫(yī)執(zhí)照的確有被吊銷的風(fēng)險，因為此事屬于欺詐。他絕對應(yīng)該被吊銷執(zhí)照。在總統(tǒng)大選期間，伯恩斯坦恩曾數(shù)次提及自己寫過那份診斷證明。這不僅是欺詐，而且造成了更嚴重的后果?！薄敦敻弧吠ㄟ^伯恩斯坦恩的辦公室試圖聯(lián)系他本人，但他的一位代表拒絕評論此事。

卡普蘭表示，理論上講，伯恩斯坦恩的爆料有可能同時引來聯(lián)邦和紐約州兩個層面的處罰，不過他認為，這種處罰可能不會超過官方批評或警告的范疇?！八_談及了特朗普服用的藥品，根據(jù)《健康保險流通與責(zé)任法案》（HIPAA），這種做法在法律和倫理上都是不被允許的?！钡ㄆ仗m也承認，事情或許不會發(fā)展到如此嚴重的地步。因為如果要對伯恩斯坦恩動用法律手段，特朗普就要提出伯恩斯坦恩違反了HIPAA的主張，而特朗普方面不太可能就此事大肆聲張?！俺鞘谴嬖趶娂椤⒅\殺或非法藥物交易等情形，要想吊銷一個人的行醫(yī)執(zhí)照也并不那么容易?！?

休斯敦的安德森腫瘤中心醫(yī)生阿尼邦·梅特爾則在推特上表示，伯恩斯坦恩承認自己在“體檢門”中參與作假一事，很可能涉嫌違反紐約州的法律。“允許、協(xié)助、教唆無行醫(yī)執(zhí)照人員從事需執(zhí)照才能從事的行為”這一條款，的確是紐約州職業(yè)辦公室對醫(yī)生瀆職行為的定義之一。

“讓無執(zhí)照的病人口述正式醫(yī)學(xué)證明，或已違反了紐約州法規(guī) 。

——阿尼邦·梅特爾

卡普蘭認為，伯恩斯坦恩的行醫(yī)執(zhí)照吊不吊銷都是小事，重要的是，如何保證總統(tǒng)候選人的健康狀況得到正確評估。他指出：“我們應(yīng)該有一個更好的體系，總統(tǒng)候選人的健康狀況應(yīng)經(jīng)過獨立的醫(yī)學(xué)評估?！碑斎?，這不等于可以公布一些無關(guān)的個人信息（比如吃不吃生發(fā)藥之類的問題）。不過獨立評估至少可以讓公眾了解總統(tǒng)候選人的真實健康狀況，同時可以避免假醫(yī)學(xué)證明這種丑聞再度發(fā)生。（財富中文網(wǎng)）

譯者：樸成奎

On Tuesday, President Trump’s former doctor Harold Bornstein dropped a bit of a bombshell in a CNN interview, claiming that the glowing doctor note he wrote for then-candidate Trump in 2016 was actually dictated by Trump himself. “He dictated that whole letter. I didn’t write that letter,” Bornstein said Tuesday. “I just made it up as I went along.” If that’s true, and combined with Bornstein’s public revelations to the New York Times about President Trump’s hair growth medication, Bornstein may be in some pretty serious legal and ethical hot water—and “absolutely should lose” his medical license, one of the country’s leading medical ethicists tells Fortune.

Bornstein claims that he faced a “raid” shortly after his February 2017 Times interview revealing the hair drug tidbit. That would suggest a major relationship change between Trump and Bornstein from 2016, when Bornstein’s medical note made what many considered hyperbolic assertions about the candidate’s health. Bornstein’s note claimed Trump would be the “healthiest individual ever elected” and that his laboratory tests were “astonishingly excellent”—wording that appeared to mimic the vernacular of one Donald Trump.

Now that Bornstein is claiming the original letter was essentially dictated by Trump (a stark turnaround from his previous assertions that the physician “really” wrote the letter himself), the gastroenterologist might face censure by the New York medical board, according to Dr. Arthur Caplan, the founding director of the Division of Medical Ethics at the NYU Langone Medical Center in New York and one of the nation’s most prominent bioethicists.

“It does risk Bornstein’s license because it’s fraud,” Caplan told Fortune in an interview. “He absolutely should lose his license. In the middle of a presidential campaign, he said he’d written [that letter] a couple of times. That’s fraud and has bigger consequences.” Fortune reached out to Dr. Bornstein through his office, but a representative declined to comment.

Bornstein’s actions could, theoretically, risk both state and federal blowback, Caplan said—although he doesn’t think anything stronger than an official censure or warning is likely. “He talked about Trump’s medications publicly. That’s a big no-no with both ethical and legal implications under HIPAA,” Caplan explained, referencing the federal medical data privacy law. But, he admitted, things aren’t likely to go that far since Trump would have to make a HIPAA violation claim. “Short of rape, murder, or drug dealing, it’s hard to lose a license.”

Dr. Anirban Maitra, an oncologist at the MD Anderson Cancer Center in Houston, pointed out on Twitter that Bornstein’s admission about the dictated doctor note could amount to misconduct under New York law. “Permitting, aiding, or abetting an unlicensed person to perform activities requiring a license” is indeed listed under the state’s Office of the Professions definitions of professional misconduct by doctors.

Letting your unlicensed patient dictate an official physician letter may be a misconduct under NY state regulations. Just saying.

— Anirban Maitra

Regardless of how the Bornstein saga plays out, Caplan asserts the bigger problem is the way in which presidential candidates’ health is assessed. “We have to have a better system. Presidential candidates should go through independent medical assessment,” he says. That doesn’t mean revealing irrelevant personal details (such as, say, hair growth medication). But an independent evaluation could go a long way toward informing the public while preventing situations like Trump’s allegedly faked doctor note.