Friday, January 14, 2005

The "Moral Interconnectedness" of Medical Care

Brennan (Brennan TA.An ethical perspective on health care insurance reform.Am J Law Med 1993:19:37-74 ) has asserted that a physician's decision about one patient affects all other patients.On first analysis this statement sees incomprehensible.. How, for example, does my prescribing a low dose diuretic to a person with hypertension -in any real existential way-affect a person three thousand miles away with a sore throat.Presumably we are not talking about some type of strange quantum physics effect where we are told somehow there is action at a distance.Why would we not assert -making just about as much sense-that a car repair decision in Atlanta affects all car owners?
He speaks of the moral interconnectedness of medical care. This cannot be taken literally so it must be intended in a metaphorical way. If metaphorical is it of the same genus as "it takes a village to raise a child" and "we are all in this together" and "global village" comments.? What is the purpose of evoking such a metaphor?
If one accepts these notions as something more than an absurd figure of speech,then the following proposal is not surprising. This is the proposal of "social justice" as a fundamental principle for the [new] medical professionalism as revealed in the Feb 5, 2002 annals of internal medicine, vol. 136, number 3, p 243-246.
Hayek's critique of the concept of "social justice" is worth serious consideration as physicians are now being told that it is a fundamental element of their professionalism.
The following are some of his analysis of this concept as described by Michael Novak. (Firstthings.com)
The term is vague and typically undefined."It is allowed to float...as if everyone will recognize an instance of it when it appears."
It can become an instrument of ideological intimidation for the purpose of bringing about some change desired by the speaker.
"Social justice" in the medical professionalism charter is "defined" as calling upon the profession to promote a fair distribution of health care resources. What remains undefined is "fair distribution" and the means to enforce this distribution and over what group of people should this distribution occur.
Only one published letter to the editor challenged the basic premises of the charter's authors.
When one reads the letter and the author's reply it is clear no reconciliation of views is possible.
Dr. Jerome C. Arnett Jr. wrote that individual rights and group rights are mutually exclusive;the authors reply "we strongly disagree". Arnett wrote than-other than under socialized medicine-the provision of services to one patient does not diminish that available to other.The authors reply "We also disagree". However, to his comment " How...is it ethical for a group such as the Medical Professionalism Project to weaken our code of ethics to promote a political agenda...?"The authors said only the charter is not a code of ethics. Apparently they choose to not deny that they had a political agenda.
When one talks about social justice, doesn't one always have an agenda ? And is not talk about "moral interconnectiveness" etc an attempt to build a base for such an agenda , however vacuous such a base may be?

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3:59 AM  
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1:06 AM  

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