Social Justice and the Doctor-Patient Relationship: A Debate

DrRich | January 25th, 2013 - 10:41 am

I interrupt this well-deserved (if I do say so myself) hiatus in my blogging career – during which I have remained busy doing other important stuff – to post this link to a debate in which I participated recently.

This Oxford-rules debate took place on November 28 at the George Washington University School of Medicine, and was sponsored by the Benjamin Rush Society.  The resolution being debated was, “The Requirements of Social Justice are in Conflict with the Requirements of an Ethical Doctor-Patient Relationship.”  I and my debate partner (Dr. Lee Hieb, past president of the American Association of Physicians and Surgeons), braved the strikingly Progressive atmosphere of the GWU campus to argue the affirmative.

The debate was spirited, and I think Dr. Hieb and I more than held our own.  I thank the Benjamin Rush Society, and especially Dr. Beth Haynes (Executive Director of the BRS) and Dr. Bruce Shaver (chapter leader of the GWU chapter) for asking me to participate.

This YouTube video of the entire proceedings is almost an hour and a half long. If you are interested in seeing my major contribution, which lasted for only 8 minutes, fast forward to the 29:30 minute mark.


6 Responses to “Social Justice and the Doctor-Patient Relationship: A Debate”

  1. Six says:

    Your lawyer analogy was a good one(though the cow story gave me a better understanding of your book title). Dr. Hieb’s reference to Karl Brandt really struck home. Brandt was a monster. How many like him will the new government medical community create?

    I thought your opponents arguments were awfully rote and formulaic. Surprisingly so. I kept hearing about ‘fair’ but precious little about the importance of the welfare of the individual patient. “I am my patients advocate, but..” That quote gave me a chill.

    I understand the idea of cutting out waste but I think that starts with malpractice reform rather than rationing. I don’t need a bureaucrat or a social worker when I’m sick. I need a doctor.

    A tie? No, my friend. You guys kicked butt. Well done.

  2. Chris FOM says:

    The opposition was pretty weak, but the sleight-of-hand was impressive. Setting up a scenario of triaging a patient, working to get a sicker one in faster than a less sick, then deftly substituting in that this is somehow “appropriately” unfair, and “advantaging a patient” to the exclusion of another and the goal of social justice is pretty disingenuous.

    The flu vaccine scenario, however, is far more revealing, and gets directly to your comments and concerns. Your opponent sets up the physician as the one who decides who gets the vaccine, while you would have an external authority make the rules while the physician works within their external framework. Speaking as a physician I know which makes me more comfortable, speaking as a potential patient I know exactly which kind of doctor I’d see and which I’d run like hell from.

  3. James Gaulte says:

    Conservative and libertarian minded viewers of the debate might have been surprised that social justice is claimed to be really all about equality of opportunity not of outcome.Your opponents repeatedly made that assertion. But they should not be surprised because egalitarian principle is that of “equal respect”, Although the egalitarians may give nominal credit to classical liberalism and its economic system of free market capitalism for bringing about unprecedented prosperity they are critical of the inequalities of wealth that such a system produces and that all members of such a society do not have equal life changes which equal respect would demand.

    Egalitarianism and social justice is then all about equalizing those life chances through governmental enforced
    redistribution-they are not talking about charity.

    Your opponents claimed concern about opportunities (which is what Rawls emphasized) but really the inequities are measured by outcome, such things as inequality of income,or housing or vaccination rates or out of wedlock birth or infant mortality.

    For conservatives and libertarians the equality is equality under the law and they speak of negative rights while the egalitarians advocate positive rights (right to housing,healthcare etc,)and the success will be measured in outcomes.In Rawls’ abstract theory it was all about equal access or opportunity in practice the key metrics are outcomes.

    So the rhetoric is opportunities and the bottom line is outcomes.Their emphasis on concern for opportunity is cover for their advocacy for coercive governmental redistribution. Being in favor of equal opportunity is mom and apple pie less so is talking about forceful redistribution.

    My thanks go out to you and Dr. Lee Heib for your efforts to shine light on the important topic you debated and ,of course,to Dr. Beth Haynes for her work with the Benjamin Rush Society.


  4. BR says:

    Dr. Rich,

    You often make the claim that Obamacare and its attendant philosophical underpinnings may mark the end of the Great American Experiment, and though I often found myself nodding in agreement with your words, I considered this opinion an intellectual indulgence. Just my dark inner conservative basking in the echo chamber. A little writer’s hyperbole. I mean really, a healthcare act is going to throw the tight spin we’ve maintained for two hundred plus year off its axis? Maybe I just needed to hear this from the horse’s mouth:

    “Your liberty is preserved if you’re able to obtain those services.(~42.44)”

    Yikes. The implications of this are of course sobering, and while I’m preaching to the Monsignor here, I have to thank you for all you’ve written. It has helped develop my perspective on healthcare more than any other single source.

  5. Albert says:

    People struggle with the meaning of “social justice”, because the people who are selling it are using all manner of high-minded rhetoric to hide what they really mean. Whether the proponents of “social justice” wish to admit it, or not, “social justice” means to them, “the wealthy should not have more toys than the rest of us”, not just health care, but everything.

    However, “wealthy” is not defined by how much money you have. Money is just how we keep track of things. By definition, “wealthy” means “someone with more toys than the rest of us”.

    So what the proponents of “social justice” are really saying is “there should be no wealthy people”. Everyone will be equally poor. That is what they have always delivered, along with tyranny.

    Tyranny is not an unfortunate side effect of a bad implementation. It is a requirement. Government enforced social justice is incompatible with freedom. In a free society, there will always be people who are more talented, more ambitious, and even sometimes more lucky, than the rest of us.

    If you want a society where “there are no wealthy people” then you must use force. “Social justice” always comes from the barrel of a gun, however high-minded its proponents try to sound. And it has absolutely nothing to do with “justice”.

  6. Cayla Cook says:

    Thank you for your post. The doctor–patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor–patient relationship forms one of the foundations of contemporary medical ethics. Most universities teach students from the beginning, even before they set foot in hospitals, to maintain a professional rapport with patients, uphold patients’ dignity, and respect their privacy.I am really delighted to read this blog posts.

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