The Wisconsin Protests and the New Medical Ethics
During the recent Wisconsin protests pitting the public-sector teachers’ union against a governor attempting to rein in their overly generous benefits, several doctors were caught on camera apparently handing out fake work excuses to the protesters. Although this might seem an outrageous breach of professional ethics, it is actually entirely consistent with the new brand of “progressive” medical ethics currently taught to medical students. And these apparent breaches of professional ethics displayed in Wisconsin may be an ominous foretaste of future problems Americans can expect under ObamaCare.
In Madison, Wisconsin, the MacIver News Service spotted a group of people in white coats purporting to be physicians agreeing to sign “sick” notes for protesters in seemingly excellent health, thus allowing them to miss work without penalty. One doctor signing notes was apparently a clinical associate professor of medicine at the University of Wisconsin.
One blogger posted the fake “sick” note he received from the doctors. He observed, “I am not a teacher, but I managed to get a note. They did not ask for any identification or where I might teach. They were literally handing these out to anyone and everyone.”
University of Wisconsin law professor Ann Althouse spoke with one of these doctors who was completely unapologetic for his actions, saying that it was “not dishonest” but rather “an ok thing to do” because it was in the interest of “social activism.”
These sorts of moral rationalizations are an entirely predictable outcome of the new form of “progressive” medical ethics being taught to American medical students.
Most Americans are familiar with the traditional version of medical ethics, in which a doctor’s primary responsibility is to his patient. As Dr. Jane Orient explains, “Traditionally, medicine is practiced by physicians, one patient at a time.... The standard of care is the Oath of Hippocrates: providing treatment for the good of each patient according to the best of the doctor’s ability and judgment.”
In traditional medical ethics, a doctor’s primary responsibility is to tell his patients the truth and to treat his patients according to his best honest judgment, skill, and ability.
But a new form of medical ethics is being taught in medical schools that tells doctors to place the needs of “society” ahead of individual patients. At best, it forces doctors to juggle the truth and the interests of their patients alongside “social” considerations. At worst, it will give them license to sacrifice their professional integrity (and their patients’ interests) in the name of “society.”
In 2002, the American College of Physicians proposed a charter in which the three guiding ethical principles for physicians would be: patient welfare, patient autonomy, and “social justice.” In 2007, the AMA ITME (American Medical Association Initiative to Transform Medical Education) reported on the importance of training medical students to be better advocates for “social justice,” and proposed changes in the medical school admissions criteria and curriculum to address this perceived inadequacy.
As a result, medical schools are now increasingly admitting students based not on competence in the sciences, but rather on their commitment to “social accountability.” Medical school ethics courses are thus increasingly emphasizing “social justice” over traditional notions of ethics — or the individual patient’s welfare. But “social justice” is frequently just a euphemism for a socialist political agenda of leftist politics, redistribution of wealth, and heavy state controls over the marketplace.
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?