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.
FOR THE RECORD:
Jay Katz obituary: The news obituary on Jay Katz, a Yale law school professor and medical ethicist, in Sunday's California section identified his stepdaughters as Mary Arthur and Emily Arthur. They are Mary Whitfield and Emily Whitfield. —
"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.
Woo is a Times staff writer.