If it's too hard to uphold ethical principles, just change them!

The Physician Charter on Medical Professionalism is a collaboration between three large professional groups (American College of Physicians - American Society of Internal Medicine Foundation, the American Board of Internal Medicine Foundation, and the European Federation of Internal Medicine) to redefine doctor's ethical responsibilities in the brave new modern era of medicine.

The Charter it taking on several controversial topics facing doctors today, including the disclosure of medical errors, and physicians' conflicts of interest.  But perhaps the most controversial area of all is how doctors are to cope with the growing need to ration health care.

The latest draft of the Charter appears to give equal weight to the doctor's mandate to give primacy to the welfare of the individual patient, and on "social justice," that is, to take into account the impact their decisions regarding individual patients have on medical resources available to others.  While several physicians taking part in formulating the Charter have objected to this radical step, so far those who would make it unethical (or, more accurately, unprofessional) for doctors to consider solely what's best for their individual patients seem to have the upper hand.

DrRich Comments:

We have examined in detail why doctors must devote themselves to doing what is best for the individual patient, and why both federal regulators and insurance carriers have systematically eroded their ability to do so.  Now, apparently, since doctors can no longer truly advocate for their individual patients, medical ethicists find it necessary to change the fundamental ethical principle of the medical profession.  Now, when doctors are considering whether an individual patient needs to have a particular test or treatment, in order to behave ethically they need to take society's interests into equal account.

Doctors, one might think, may have trouble discerning what "society's" interests are.  But it's really not that hard.  HMOs, PPOs, or Medicare represent quite clearly to doctors what society wants.

Until now, the incredible pressures brought to bear on doctors by the feds and insurance carriers - pressures that often lie in direct opposition to the interests of the patient - created a difficult ethical dilemma.

But if the Charter survives in its current form, that ethical dilemma will simply melt away.  It's OK, after all, for doctors to do what's best for society when making those tough (but covert) rationing decisions.

July, 2001

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