The Wisconsin Protests and the New Medical Ethics

This new approach to medical ethics was exemplified clearly by the young family medicine physician who told Ann Althouse that writing questionable work excuses was morally proper (“an ok thing to do”) because it served the greater “social” goal of helping the Democratic-backed government employee union against the Republican governor.

But what happens when this new breed of doctors start applying those same ethical principles in regular clinical practice? Under ObamaCare, many of these physicians will no longer work in traditional private practice but rather in large Accountable Care Organizations (ACOs) where they will treat patients according to government-specified “cost-effectiveness” guidelines. These guidelines will often be constructed to save money for the government entities paying the bills (such as Medicare and Medicaid), even at the expense of the patient’s well-being. We’ve already seen this in the government’s recently failed attempt to impose similar cost-effectiveness guidelines that would have restricted screening mammograms to women over age 50 (even though research has shown a clear medical benefit to starting screening mammography at age 40).

Fortunately, numerous doctors chose to ignore those guidelines and continue practicing in their patients’ best medical interests according to their traditional ethical training. And under pressure from outraged physician and patient groups, the federal government eventually withdrew those “cost effectiveness” mammography guidelines.

But what will happen under a new generation of doctors who have been taught that the individual patient’s welfare must be balanced with “social” considerations — such as the cost to the government or to “society”? Suppose you see one of these newly trained doctors at the local Accountable Care Organization because you are suffering from the worst headache of your life. He performs a brief physical exam, then tells you that according to the new ACO practice guidelines, you don’t need a MRI scan of your brain — just take two Tylenol and call him in the morning. Can you be 100% sure that he’s truthfully advising you in your best medical interest? Or might he be compromising your medical interests to satisfy the ACO bean counter who will reward him based on how many MRI scans he saves the organization?

The new medical ethics allows doctors to salve their consciences by telling themselves that restricting care to patients serves the greater “social” good. Most people have a powerful (and natural) need to believe that the work they are doing is morally worthwhile. Very few people can knowingly work in a fashion they believe to be ethically wrong. The new code of medical ethics gives doctors the internal psychological moral “cover” they need to allow themselves to continue practicing according to government guidelines. It allows them to act as agents of medical rationing, while telling themselves that “I’m just being socially responsible” — the 21st-century medical version of, “I was just following orders.”

The Wisconsin protests have shown how some doctors are seemingly willing to subvert their professional integrity to serve the political ends of government special interest groups. Under ObamaCare, when similarly trained doctors have to choose between practicing in their patient’s medical interests or in the political interests of their government paymasters, which side will they choose? And will you want this new breed of doctor taking care of you when you’re sick?