Sunday, November 23, 2008

Deceased--Jay Katz

Jay Katz
October 20th, 1922 to November 17th, 2008

"Dr. Jay Katz, influential expert on medical law and ethics, dies at 86"

Longtime Yale professor served on the panel that led to the end of the Tuskegee experiments. His advocacy helped shape the practice of informed consent for patients involved in medical research.


Elaine Woo

November 23rd, 2008

Los Angeles Times

Dr. Jay Katz, a psychoanalyst and Yale Law School professor whose analysis of the conflicting interests and motivations of doctors and patients made him a leading authority on medical ethics, died of heart failure Monday in New Haven, Conn. He was 86.

Katz was best known for his 1984 book "The Silent World of Doctor and Patient," which examined the complex factors that shape the physician-patient relationship and hinder the medical decision-making process.

"This was his most significant work. . . . It has been very influential in shaping the thinking of bioethicists on the doctrine of informed consent," said Alexander Capron, a USC professor of law and medicine who co-wrote books with Katz.

Katz was a forceful advocate for patients involved in medical research.

In the early 1970s, he was a member of a national panel that investigated the Tuskegee syphilis experiment, in which researchers from the U.S. Public Health Service withheld treatment from 400 rural Alabama black men in order to observe the progress of the disease. Some men were allowed to die during the 40-year study, which ended in 1972 at the urging of the panel.

Katz said the Tuskegee subjects had been "exploited, manipulated and deceived. They were treated not as human subjects but as objects of research."

In 1993, he was named to a presidential commission that documented the exploitation of research subjects in post-World War II studies on the effects of radiation.

He also was a severe critic of a UCLA study in the early 1990s in which researchers withdrew medication from schizophrenics to determine which patients could safely stop taking the drug. One of the patients committed suicide while another attempted to kill his parents and threatened to kill then-President George H.W. Bush.

The UCLA team was reprimanded in 1994 by the National Institutes of Health, which said the researchers failed to adequately explain that patients risked relapsing as a result of the experiment.

In Katz's view, the researchers misled the study participants by failing to tell them that the ultimate purpose was not to treat their illness but to gather information that would benefit future patients.

"There is persistent confusion between research and [clinical] practice and the obfuscation of the two," Katz told The Times in 1994. "You cannot use people -- or you should not use people -- as means for others' ends and for ends that might ultimately even be good."

He urged doctors and patients to share the responsibility of making medical decisions by talking honestly to each other about the uncertainties of treatment, their expectations and the role each party must play, a radical idea given the long tradition of physician paternalism and patient passivity.

"As a doctor steeped in the law, Jay Katz illuminated better than anyone has before or since, the complex of medical, legal and ethical choices that haunt the silent world of doctor and patient," Harold Hongju Koh, the dean of Yale Law School, said in a statement last week.

Katz, who was the school's first professor of law, science and medicine, made major contributions in a number of areas, including family law and reproductive technology.

He spoke sternly against a change in federal regulations in 1996 that allowed investigators in some medical studies to enroll patients who are unable to give their consent because of a head injury or other life-threatening condition. Katz said the change violated the Nuremberg Code, developed after the Nuremberg trials of Nazi doctors after World War II, which said that nothing should be done to a human being without his or her approval.

He also was a vocal opponent of scientists' use of data from experiments that Nazi doctors conducted on concentration camp prisoners during Hitler's reign.

These issues resonated particularly profoundly for Katz, who was born Oct. 20, 1922, in Zwickau, Germany, and witnessed Hitler's rise to power. He endured intense harassment by teachers and classmates as the only Jewish student in a school for the gifted. His father, a prominent businessman, was arrested by the Gestapo.

That experience "gave him a special allergy, one might say, to people who abuse their authority and abuse vulnerable people who are dependent on them," said Robert Burt, a Yale Law School colleague and longtime friend.

One by one, Katz's family, including his father, escaped Germany. In 1940, he arrived in the U.S., soon to be joined by the rest of his family. He graduated from the University of Vermont in 1944 and became a U.S. citizen in 1945. He earned his medical degree at Harvard University in 1949.

In 1951, he joined the Air Force, serving at the military hospital at Maxwell Air Force Base in Alabama. He attained the rank of captain before completing his service in 1953 and joining Yale.

He wrote several widely cited texts, including "The Family and the Law" (1964) with Joseph Goldstein; "Psychoanalysis, Psychiatry and Law" (1967) with Goldstein and Alan M. Dershowitz; "Experimentation with Human Beings" (1972); and "Catastrophic Diseases: Who Decides What?" (1975) with Capron.

At his retirement in 1993, he was the Elizabeth K. Dollard professor of law, medicine and psychiatry.

He married Esta Mae Zorn in 1952; she died in 1987. He is survived by his second wife, Marilyn; a son, Daniel; two daughters, Sally Katz and Amy Goldminz; two stepdaughters, Mary Arthur and Emily Arthur; a brother, Norman; and four grandchildren.

"Dr. Jay Katz, 86, Dies; Explorer of Ethics Issues"


Dennis Hevesi

November 20th, 2008

The New York Times

Dr. Jay Katz, a physician and a professor at Yale Law School who spent more than 40 years tackling confounding questions on the boundaries between law, medicine, psychology and ethics, died Monday at his home in New Haven, Conn. He was 86.

The cause was heart failure, his son, Dan, said.

Among the issues that Dr. Katz explored as an outspoken public advocate were medical experimentation without patient consent; whether frozen embryos deserved consideration as potential human beings; and the rights of biological parents whose children lived with adoptive parents.

"He posed these often unanswerable questions," said Alan M. Dershowitz, the Harvard law professor, who in the 1950s was one of Dr. Katz's first students at Yale. "He would ask, for instance, 'Did somebody intend to kill?'" Mr. Dershowitz recalled on Tuesday. "Let's say it was a case involving somebody who killed while sleepwalking. The law narrowly says that person did not intend to kill, whereas psychoanalysts say that maybe, at a deeper level, he did. Jay broke down disciplinary walls."

If many of the questions Dr. Katz dealt with were debatable, there was no doubt where he stood on medical experimentation without informed consent. In 1972, he was named to a federal panel to investigate the Tuskegee Syphilis Study, a 1932 experiment by the United States Public Health Service in which about 400 infected black men in Alabama were left untreated, with their outcomes compared with those of about 200 healthy men. The investigation found that at least 28 of the men died as a direct result of syphilis and many others suffered severe damage to the central nervous system, heart trouble or other ailments.

The panel described the study as "ethically unjustified." It said penicillin should have been made available to the infected participants in later years and it called for federal protections for medical research subjects.

Dr. Katz said the report did not go far enough. He issued a statement saying that the participants had been "exploited, manipulated and deceived."

A year after the Tuskegee report, Dr. Katz served on a panel of prominent academics who called for a moratorium on the use of poor people as subjects of medical experimentation.

Dr. Katz had been hired as a physician by Yale in 1953 and soon became the chief resident of the outpatient clinic at the university’s medical school. He began teaching psychiatry at Yale in 1955 and three years later was appointed to the law school as an assistant professor of psychiatry and law. He retired in 1993, but taught until recently as an emeritus professor.

"As a doctor steeped in the law," Harold Hongju Koh, the dean of the law school, said in a statement, "Jay Katz illuminated better than anyone has before or since the complex of medical, legal and ethical choices that haunt the silent world of doctor and patient."

The sometimes blurred line between medical ethics and the law was a theme of many of Dr. Katz's books, which include: "The Family and the Law," written with Joseph Goldstein (1964); "Psychoanalysis, Psychiatry and Law," with Mr. Goldstein and Mr. Dershowitz, (1967); "Experimentation with Human Beings" (1972); "Catastrophic Diseases: Who Decides What?" written with Alexander M. Capron (1975); and "The Silent World of Doctor and Patient" (1984).

Jacob Katz was born on Oct. 20, 1922, in Zwickan, Germany, one of two sons of Paul and Dora Ungar Katz. His father owned a department store. When Jacob was 11, the Nazis came to power and his family’s citizenship was revoked. His father managed to get him a Czech passport. At 16, on his own, Jacob went to Prague, and then, by way of Italy and England, made his way to New York, where he found work in an auto parts store. The rest of Jacob's family followed in 1940.

Four years later, he graduated from the University of Vermont, and in 1949 he received his medical degree from Harvard. He then served as a captain in the Air Force.

In 1952, Dr. Katz married Esta Mae Zorn; she died in 1987. Besides his son, he is survived by his second wife, Marilyn Arthur; two daughters, Sally Katz and Amy Goldminz; two stepdaughters, Mary Arthur and Emily Arthur; a brother, Norman; and four grandchildren.

If there was one revelation that most focused Dr. Katz on issues of medical ethics throughout his career it was the unspeakable experiments performed by Nazi doctors during World War II.

He expressed consternation in 1996 when the Food and Drug Administration revised 50-year-old federal regulations to allow medical researchers to enroll patients in some studies without their consent. Although the new rules could be applied only in carefully circumscribed situations, they stepped back from a principle dating back to the Nuremberg War Crimes trials, when American judges wrote an international code of medical ethics.

"It's a fateful step," Dr. Katz told The New York Times in a telephone interview from Germany, where at the time he was about to give the keynote speech at a conference in observance of the 50th anniversary of the doctors' trials at Nuremberg.

"The first sentence of the first principle of the Nuremberg Code," he said, stated that no research on human beings should be done without their consent. And now, he said, "here we are making exceptions."

"The revised rules remain in effect and are very controversial," the University of Pennsylvania ethicist Arthur L. Caplan, a friend of Dr. Katz, said Wednesday. "We fight about them all the time."

Dr. Robert Levine comments at the Lifetime Achievement Award for Excellence in Research Ethics presentation at the 2001 Annual IRB Conference on December 3rd, 2001:

Today we are assembled here in Boston to honor Jay Katz for his distinguished contributions to the field of research ethics. It is fitting that Jay be the first recipient of PRIM&R's Lifetime Achievement Award for Excellence in Research Ethics. His enormous contributions to this field began before research ethics was even recognized as a field of study.

Jay was recognized as a major thinker on the topic of what was then called ‘human experimentation’ in the late 1960s. This recognition was symbolized by his inclusion as a contributor to the first major symposium on this subject (the proceedings of which were published in the book, "Experimentation with Human Subjects," edited by Paul Freund and published in 1970), and by his membership in the early 1970s on the Tuskegee Syphilis Study Ad Hoc Advisory Panel. His position of eminence in the field was established securely with the publication in 1972 of his monumental casebook, "Experimentation with Human Beings."

Exactly what is Jay's great contribution to research ethics? The criteria for measuring contributions in research ethics are very different from those used in the natural sciences. In the natural sciences we can connect very concrete contributions to specific individuals. We can say, for example, that three individuals named Fleming, Florey, and Chain each played a vital role in the discovery of penicillin and the recognition of its importance as a therapeutic agent. We can further say that the importance of these discoveries is such that these three deserved to share in the Nobel Prize.

Unlike natural science, scholarship in ethics does not primarily entail discovery and validation. No one can tell you who invented or discovered informed consent. Ethics is concerned with the examination of a cultural tradition with the aim of understanding what behaviors or personal attributes are considered morally praiseworthy or blameworthy by members of that tradition. Ethics is also concerned with understanding how the tradition can be interpreted and adapted to make it relevant to the present time with all of its novel social, economic, technological, and other contingencies.

The great contributors to the field of ethics are those who are capable of understanding the 'big picture' in a way that enables them to figure out where any particular issue fits in with the overall structure of the tradition. The great contributors have mastered the large body of information; have applied sound analytical methods to the resolution of particular problems and sound critical methods to the resolutions proposed by themselves or others; have synthesized their findings and those of others into new comprehensive accounts of the field and have effectively communicated the fruits of their efforts to others.

We are here today to celebrate Jay Katz because his work in research ethics exemplifies all of the features of a great contributor to the field. The fact that he is one of the world's greatest mensches just makes it more enjoyable for PRIM&R to do the right thing.

And at the same gathering, Joan Rachlin spoke:

As a small non-profit organization, it took a while—28 years to be precise—for PRIM&R to decide to bestow an annual Award on an individual whose contribution to the field of research ethics was significant. Once that decision was made, though, the matter of to whom the first such award should go was resolved with breathtaking speed! Jay Katz has been the moral compass of the research ethics field since the publication of his groundbreaking book "Experimentation with Human Beings" in 1972.

When I completed my Master’s Degree in Public Health and was thereby able to officially call myself a "health lawyer," a friend sent me a cartoon showing two people meeting at a cocktail party, apparently for the first time. The caption read, "I inhabit that shadowy world between law and medicine." Thanks largely to Jay Katz, many of those shadows have been erased by his illuminating and inspiring writings which demand that we pay attention to ethics in research, which means, in large measure, paying respectful attention to those individuals who participate as subjects.

With brilliance, an accessible and ever-lucid writing style, an unerring understanding that "those who do not remember history are doomed to repeat it," endless energy, steely determination, and mostly, enormous heart, Jay Katz has been our beacon and our conscience as we work to ensure that "never again" means just that.

This volume is therefore presented to Jay with great respect, admiration, and love on the occasion of his being the inaugural awardee of PRIM&R's Lifetime Achievement Award for Excellence in Research Ethics. Having such an extraordinary first recipient does PRIM&R great honor, and on behalf of our community, we thank him for the gift of both his work and his determination to make research ethics a cause, and not just a career. Thanks to Jay Katz, a field was born and the seeds of hope and knowledge have been planted therein. May it long continue to bear the fruits of his prodigious and much-needed labors, and may Jay long continue to be our cherished teacher and fearless leader!

Joan Rachlin, JD, MPH
Executive Director

Selected solo and co-authored books:

Catastrophic Diseases: Who Decides What? : A Psychosocial and Legal Analysis of the Problems Posed by Hemodialysis and Organ Transplantation

ISBN-10: 0871544393
ISBN-13: 978-0871544391

Experimentation With Human Beings; The Authority of the Investigator, Subject, Professions, and State in the Human Experimentation Process

ISBN-10: 0871544385
ISBN-13: 978-0871544384

Family and the Law. Problems for Decision in the Family Law Process


Psychoanalysis, Psychiatry and Law


The Silent World of Doctor and Patient

ISBN-10: 0801857805
ISBN-13: 978-0801857805

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