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Friday, January 11, 2013

45 years after receiving Med school diploma, I realize I am an unethical physician

I had thought for the past forty plus years that by acting as the fiduciary to my patients and by striving to help them,not harm them and respect their autonomy as individuals I would be an ethical physician. However, in recent years I have learned that by my failure to accept the egalitarian  philosophy and to strive for social justice and to act as a steward to society's medical resources, I have fallen far short of the medical ethical ideal and to act as is now thought appropriate for a medical professional.

I suppose I owe gratitude to the internists from both Europe and the United states whose combined efforts lead to the publication of the New Professionalism as explicated in  A Physician's Charter which made clear to me my ethical lapses. The Charter did not merely reaffirm the appropriate behavior between a physician and a patient but it announced how a physician should behave "towards society". 2012 saw the tenth year anniversary of its publication and I commented here regarding that achievement.

I cannot be an ethical physician because I find the concept of social justice to be vague and imprecise and open ended , a term that can be used to rhetorically justify any and all programs to redistribute and which lacks well defined (I argue undefinable) rules to determine exactly what is just.I cannot enlist to work for a concept that has no unambiguous definition and lacks anything resembling operational rules as to how to decide what is just in that formulation.

I cannot be ethical because I find the justice of redistribution to be antithesis of the justice of freedom and as best I decipher the meaning for many of  social justice it is that is  the justice of redistribution.

I cannot be ethical because I believe the concept of physicians as stewards of society's resources is sophistry and is bogus on multiple levels and is a dangerous notion. First of all, society does not have resources. there is no one named society . Society does not choose and society does not own. Individuals choose and individuals own.If one accepts the idea that individually owned assets are part of a societal pool, the next step is to correct whatever distributional inequality some observer feels is ripe to redistribute to mitigate some alleged or real inequality. As long as individuals are free to act in their own self interests within the limits of a democratic country there will be an endless array of inequalities that beg for correction in the eyes of the egalitarian.

I cannot be an ethical doctor because I consider the notion of steward of medical resources of a collective owned ( in some open ended, undefined sense) as a means or a mechanism to control medical care. The concept is both bogus and potentially dangerous.I do not believe that the intent of many of the stewardship advocates is that physicians will  each individually act to conserve resources according to their own assessment of how best to conserve or preserve simply by not ordering  "low value" tests and procedures. Rather we are talking about elite supervisory stewards who through some mechanisms such as cost benefits analysis will provide guidelines through the adherence to which the individual physicians stewards can accomplish collectively the preservation of society's resources and move towards greater social justice ends not achievable through what they believe the archaic and socially destructive selfish machinations of the physician- patient dyad.Doctor,we realize you are too busy and your capabilities too limited to do much personally to conserve the collectively owned resources and further justice but if you just follow the utilitarian based,cost effectiveness guidelines that will suffice.

I cannot be a ethical physician because of my objections to the egalitarian philosophy are so wide and so deep and that I believe the notion of redistribution is simply put a very bad idea. Why so?
Wealth is not created by redistribution and the enterprise of redistribution knows no ends. there will always be inequality of one sort or another along some scale of comparison.  The hubris of those who see an inequality along some axis presume that they know somehow to realign things to make things better (or more equal) as measured by some collective aggregate is more than I can tolerate. My priors are so strongly pro freedom that  a philosophy based on limited of freedom  is not acceptable to me.

I cannot be a modern, ethical physician because of my views about the very core of egalitarianism which included the notion that inequality needs to be corrected by government action.This assumes that the government can act as a disinterested agency capable of rationally correcting market failures and acting in the public interest and carrying out the public will.  All of that is an absurdly romantic notion of how the world works. It is a view that folks such as Jefferson and Madison understood well to be absurd but too many people have either forgotten or never understood and has been replaced by the 10th grade civics class notion of how government works. If you believe that government entities are collections of individuals acting in ways to achieve outcomes consistent with their own interests and often those of special interests you will not buy into the bogus notion that justice will served by governments acting to rectify inequalities .

If you buy into the basic outlook and beliefs of classical liberalism ( i.e.libertarianism) you cannot be an ethical physician if that definition of ethical includes the mandatory acceptance and practice of egalitarianism.

Though I cannot  be a ethical physician according to the ethical principles devised by the authors of the new professionalism and the medical ethics of the American College of Physicians at least I can hope that when father time and apoptosis  take their toll on me to the point when I need medical care  there will be physicians who have the ethical stuff to act as stewards and be sure that my personal interests will not over ride those of society.


Unknown said...

I had SO many thoughts about this that I reactivated my own blog to respond. http://firstcoldmurmur.blogspot.com/2013/01/you-built-that-you-just-didnt-do-it.html

Anonymous said...

Overblown irony and sarcasm concerning social justice can bring out some pretty strong feelings.

UKVin said...

Hi James, liked your soul searching and your new insights. I also agree with you that our society has become more and more individualistic. People help each other out of their free will.

There is no compulsion on any body to share a part of their resources with the needy ones.

But then what should be the ideal model of governance then? because I did not find the 'egalitarian model' of the so called 'socialist countries', a system which breed inefficiency and corruption.

Anonymous said...

Flamboyant reactions to this kind of thinking shouldn't surprise anyone, Doctor. I find that whenever Social Justice is criticized or attacked outright, its True adherents' reactions seem reminiscent of those who burned heretics at the stake. Remember, Social Justice is the central dogma of the new canon, and it has been my observation that its defenders most frequently label its attackers as members of a malevolent outgroup, usually one that enjoys profiting at the expense of others or succeeding as a result of broad and innovative social structures that exist ostensibly for the betterment of mankind. Of course, those attacking Social Justice are assumed to ignore or discount any greater benefits that society may impart on individuals in their insistence on the primacy of the individual. For once, just for once, I'd like to hear one of my colleagues who proselytize the Justice angle sit down and admit that maybe, just maybe, they didn't understand human nature to the extent that their overarching plans for organizing the many facets of each of us, all three hundred million, just might not trump my desire to be left to my own devices to a reasonable degree. The same force that drove the crusaders south time after time throughout antiquity must drive the modern Justice crusader as well, because the desire to abstain from society's grand new plans for me (and perhaps your desire as a physician to sit it out as well), aside from paying for the public resources I use, evidently makes me an object of continual inquisition. After all Doctor, what kind of a sin is that?