Featured Post

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 ...

Friday, June 03, 2016

Politicalization of medical ethics-you have to ask why and by whom

The politicization of medicine is cogently  discussed  by Dr. Thomas Huddle. See here for an abstract of his article.

First, with the publication of the Charter, Professionalism in the New Millennium in 2002 the notion of social justice was injected into the listing of attributes and behaviors that physicians should exhibit to act professionally.Rather than a well reasoned and documented  argument for such action being presented by the authors, we saw a series of gratuitous assertions.

Subsequently a commitment to social justice was declared to be an ethical imperative in the American College of Physicians'  (ACP) ethics manual. Other professional organizations followed suit pledging at least rhetorical support of the inclusion of social justice into their ethical propositions.

 Dr Huddle, who teaches at University of Alabama Medical School at Birmingham, says in part:

1) civic virtues are outside the professional realm, (2) even if civic virtues were professionally obligatory, it is unclear that civic participation is necessary for such virtue, and (3) the profession of medicine ought not to require any particular political stance of its members.

"Advocacy on behalf of societal goals... is inevitably political".

" civil virtues are outside of the professional realm" and " the profession of medicine ought not to require any political stance".

Requiring a commitment to social justice is clearly  political and requires physicians to take a particular political stance and a particular philosophical position..Advocacy for social justice is one feature of the modern liberal or progressive political stance.Such advocacy is not typically part of the conservative political viewpoint or the libertarian ( aka classical liberal) position.

The notion of justice upon which which the country was founded  was that of the justice embodied in the rule of law,i.e. treating everyone equally under the law. The foundational notion of the social justice line of thinking is essentially that treating folks who are unequal equally is unfair and unjust and therefor there must be societal ( i.e governmental)  effort to mitigate inequality by  re-distributional  and other coercive  efforts of the state.

The physicians who authored the Charter and the ACP's new ethics would appear to be of the progressive belief system  while there are many physicians in the country who are not. A small group of what I have labeled as the "medical progressive elite" have seemingly captured the conversation and are attempting to  profoundly alter traditional medical ethics.To the extent that they and similar minded individuals set the agenda of major medical professional organizations and medical students education they may have succeed. but I wonder how many practicing physicians are even aware of the views that they pretend to be a settled issue.

Why would such an effort be launched and well funded ? Who gains from efforts  to bring about a sea change in traditional medical ethics? The answer to that may be found in the plan that the elite medical progressives later introduced to enable practicing physicians to on  a day by day basis practice social justice.Simple they just had  to follow guidelines .In that way there would be an alleged greater benefit to the collective -although sometimes at the expense of the individual patient-and presto we have a utilitarian form of social justice with the collective and of course third party payers benefiting.Is this the "why"?

Note: An shorter version of this essay had been published previously. I redo it now because sadly a version of social justice seems to be firmly appended to medical ethics,on paper if not in practice and few voices are heard in opposition.I find physicians believing that they should work for the good of the group or the collective or society a very frightening notion, one with a slippery slope  as evidenced by what went on in collectivist societies in the last century.

No comments: