Medical Ethics Redefined for the Times

When it becomes difficult to follow a set of ethical principles, what is one to do?

It's easy - simply recast the principles to make them more palatable.

The American College of Physicians-American Society of Internal Medicine and the European Federation of Internal Medicine published a new definition of medical professionalism in the February 5 issue of the Annals of Internal Medicine.  The need to redefine medical professionalism was necessitated because "Physicians today are experiencing frustration as changes in the health care delivery system" challenge "medicine's commitment to the patient."

There are now 3 fundamental principles that define medical professionalism: 1) primacy of patient welfare, 2) patient autonomy, and 3) social justice. 

This latter principle specifically requires doctors to work for "fair distribution of health care resources." And by this, "physicians are required to provide health care that is based on wise and cost-effective management of limited resources."

DrRich comments:

On their face, there is nothing wrong with these principles, even the third one.  Doctors really should work for social justice.

But our current method of rationing health care (and "rationing" is what they mean by "fairly distributing health care resources") is to force doctors to ration at the bedside, without disclosing to their patients that that is what they are doing.  Indeed, the need to ration covertly is precisely what is "frustrating" doctors today, since it violates the real fundamental principle of medical professionalism - to place the welfare of their individual patients above all else. You can't do that and covertly ration care, too.

So the new list of principles may give some physicians succor.  "Sure, I'm violating #1, but I've got to do that to accomplish #3".  If doctors can avoid too much introspection and self-analysis (which shouldn't be a problem for many physicians,) the new principles will give them some cover.

If we had a system of open rationing - a set of clear, open, society-approved rules for who gets what, and when - then doctors could actually follow all 3 of these new principles.  But as long as doctors are supposed to ration covertly, without admitting to themselves or to their patients that that's what they're doing, then no set of ethical principles can rescue them.

Nice try, though.

March, 2002

Back to news and commentary

YourDoctorintheFamily.com Home Page