Friday, November 29, 2013

Do the new medical professionalism and new ethics conflict with the notion of "rule of law"?

Both the new medical Professionalism and the current rendition of the ethics of the American College of Physicians have added to the long standing ethical precepts of  patient welfare and patient autonomy the ambiguous notion of "social justice".I use the term "ambiguous" because in neither proclamation do the authors clarify exactly what they mean by social justice.Later writings by the ABIM foundation,an organization closely linked to the ACP seem  to equate social justice to conservation of medical resources which seems to me to be at best an idiosyncratic use of the term.

Although many  would consider social justice to be something along the lines of  " trying to help the less fortunate " or at least a sincere concern for the disadvantaged, many equate social justice to re distributional justice and that  seems to be a widely accepted meaning. Against the first informal definition few would raise objections but there is a long history of political economic thought in opposition to the second including principles prominent  in the founding of the United States and dates back at least to John Locke and others typically characterized as classic liberals.

So what does the quest for social justice have to do with the rule of law?

According to some,most notably,  F A Hayek, social justice in the sense of distributive justice is inherently incompatible with the rule of law.Basically this is because the progressive philosophical position which include efforts to bring about social justice favors  efforts to redistribute resources or services to lessen inequality along some purported  axis while the rule of law proposes treating everyone the same and promotes the rule of law as opposed to the rule of man. The progressives  oppose treating everyone the same because treating unequals equally likely results in no lessening  of the inequality which is the "polar star" of the progressives much as liberty could be said to be the polar star of the classic liberal thought, now referred to as libertarianism.

Hayek speaks of social justice a being "devoid of specific meaning " but "fraught with insinuations" that are dangerous and erroneous. He believed that people who use the term do not know themselves what the mean by the term.

To Hayek justice referred to a process while the progressives  (on modern liberals) consider justice as a result. Hayek favored a society in which coercion was limited as much as possible  and believed human freedom was dependent on general rules that carved out domains of activity that were exempt from government power.

The classic liberal view point  strands in clear opposition to the  view espoused by the modern liberal  also known as progressive. If there is a cogent argument for the proposition that a physician must adhere to the progressive view and act accordingly to be considered ethical it has not been made. Rather certain organizations- most prominently The American College of Physicians and the American Board of Internal Medicine Foundation- have gratuitously asserted that support of social justice is a fundamental precept of medical ethics and medical professionalism.These advocates have attempted to make a political goal ( redistribution and social justice) an ethical requirement of physicians.

Dr Thomas Huddle of the University of Alabama Medical  School said:

"Advocacy on behalf of societal goals... is inevitably political".
and
" civil virtues are outside of the professional realm" and " the profession of medicine ought not to require any political stance".

Dr Huddle co-authored the following along with Dr. Robert Centor:

..we should not assume that the pursuit of social justice is an integral aspect of physician identity,despite numerous assertions to that effect.We contend that social justice is a civic virtue that makes its claims upon physician as citizens.If we are obligated to further health care access for every member of society,we have that obligation as members of society,not as physicians.Promoting nonprofessional virtues or ethical imperatives is not the province of professional ethics.

So, in answer the the question posed by the title-yes. Would physicians hung up on the archaic notion of the rule of law be considered unethical?

 Minor changes ,word order and spelling, made on 7/31/14 and again on 8/15/14 and 8/31/14.

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