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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Monday, November 16, 2015

Which goal of the ABIM Foundation is not part of traditional medical ethics?

The ABIM Foundation's mission is  putting the Charter ( insert full name) into practice. The Charter's main themes are patient welfare,patient autonomy and social justice. In their own words the ABIM Foundation to advocate for " a just and cost effective distribution of finite resources." Are just and cost effective independent characteristics i.e  do these modifiers represent different things? Could a distribution be cost effective and unjust? Certainly- at least  by some definitions of what is justice. Rawls has stated that a distribution that is unequal can only be just if it benefits the most disadvantaged. A cost effectiveness decision does not necessarily advantage the least advantaged members of society.

Could a distribution be just and not cost effective. A significant part of our society is designed with a eye toward achieving justice without  cost considerations. It would be much more cost effective to eliminate most all of the rights of the accused in our criminal justice system and simply take all person accused of a crime out and shoot them. The Bill of Rights did not go through a vigorous cost effectiveness analysis before its acceptance. So the ABIDF's advocacy would seem to be for  things that are both just and cost effective yet in Rawls's ethical scheme cost effectiveness is not just because it ignores the separateness of individuals and may sacrifice some individuals welfare for some greater aggregate utility.Or maybe the authors of the ABIM pronouncements just thought the words sounded good together.

Of course, the social justice element of the Charter is what is not part of traditional medical ethics.

The above  quote explains what the social justice element of their mission is about i.e their version of social justice- just and cost effective distribution of medical resources.

D B Wolfson says in regard to their " choosing wisely" program  is about "exactly the care than is needed".

The physicians in the social justice advocacy world of the ABIM Foundation will play key roles in this just and cost effective distribution of finite resources.Actually there will be two levels of activity. Fist there will be the physician planners and analysts who will "determine" what is cost effective and what is not and what is just  and secondly there are the worker bee physicians (or more broadly the health care providers) who will carry out the details of the just and/or cost effective distribution through directives euphemistically called guidelines. In this way the physicians will fulfill their roles as stewards of the finite medical resources. To determine what is just and cost effective is far beyond the pay grade and technical and professional expertise of the practicing physician and must therefore be left to those with special training and expertise.

Implicit in this construct is the collective ownership of the medical resources. Implicit is this construct is the incredibly overgrown hubris of those who claim they are not only able to determine what is best for the individual by for society as well while  providing "exactly" the care that is needed.

The history of the twentieth century should have made it clear how central planning on a social level works out. Even a cursory survey of what transpired in Russia,in communist China,in India in the era of the collectivization of the farms  and the current Korean peninsula should disabuse anyone of the notion that central planning is the way to go..Galbraith recommended Soviet styled five year plans,in India. Yet central planning of medical care is exactly what Drs. Brennan and Berwick recommended in their  "New Rules".

But this time it will be different.Planning for the millions of people in regard to their health care. this time it will be rational and determined to be of  "high value" and the good of all will be achieved though a rational plan providing what some group of platonic guardians have determined exactly what everyone needs, you know the right medicine for the right patient and the right time


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