On Parsimonious Care

DrRich | February 2nd, 2010 - 10:54 am

Regular readers will know that Dr. Virginia Hood, Chair of the American College of Physician’s Center for Ethics, Professionalism and Human Rights, has responded on behalf of the ACP to DrRich’s challenge to debate the New Ethics being promulgated by the ACP (and sister organizations) – and that the ACP’s response was the functional equivalent of an ethics Dear John letter.

The gist of this formal reply was: “There is no ethical issue here at all. It is quite surprising that anybody would take issue with the New Ethics. And indeed “nobody” has.”

DrRich, suitably brushed off, has already delivered his analysis of the ACP’s statement, a disappointing statement which left the fundamental ethical question (namely, why the New Ethics has rendered covert bedside rationing the ethical duty of physicians) not only unanswered, but unacknowledged. So much for the proposed “debate.”

So DrRich, who back in the day was the recipient of his rightful share of Dear John letters, knows his role here. The ACP is preening for the office of Virgin Queen of the Prom, and DrRich – the jilted boyfriend who knows she’s been sleeping with the lacrosse team – is supposed to keep out of the way and shut up. And so, while he reserves the right to elaborate on some of the more surprising implications of the New Ethics, he recognizes that the ACP (and likely the 120 other physician organizations that have signed on to this manifesto) are very satisfied with their new ethical standards, and are not interested in revisiting them.

But before finally leaving the ACP entirely to its own devices, dear readers, DrRich hopes you will forgive him if he cannot resist commenting on just one more, particularly curious aspect of Dr. Hood’s reply. He refers to her remarkable injunction that, in order to meet their new ethical obligation towards the fair distribution of society’s resources, physicians should engage in “parsimonious care.”

DrRich was pretty sure he knew what parsimonious meant, of course. But the fact that the Chair of the ACP’s Center for Ethics (&c.) was now specifically enjoining doctors to practice medicine parsimoniously made DrRich wonder if perhaps he’d gotten it wrong. So he decided he’d better look it up.

The common meaning for parsimonious, and the only meaning supplied by most dictionaries (such as Webster’s New World Dictionary) conveys the sense of stinginess, or extreme frugality. Other dictionaries and thesauruses suggest: excessively unwilling to spend, ungenerous, penurious, penny-pinching, miserly, sparing, grasping, tight, close, niggardly, illiberal, mean, avaricious, covetous, and tight-assed. Illustrated dictionaries are likely to show a picture of Jack Benny or pre-ghost-of-Christmas-Future Ebeneezer Scrooge, though children’s dictionaries will likely depict Scrooge McDuck, and if progressives had their own dictionary (and they certainly need one of their own), they would show a Republican elephant.

So it would certainly appear that the “parsimonious care” which Dr. Hood urges physicians to adopt hardly seems the kind of medical care patients would hope to receive, or that most doctors would aspire to give.

Perhaps, one might think, Dr. Hood simply misspoke in this instance. Indeed, if one can manage to work one’s way through the entire sentence (which reads, “Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.”), it might be just possible to believe that perhaps she only meant “efficient.” And (one might speculate) in her hurry to toss off a quick reply to DrRich this past Sunday, no doubt so that she could get back to the Pro Bowl, she simply chose the wrong word inadvisedly.

But that’s not what happened. Dr. Hood did not misspeak. In fact, these words are not hers. She is quoting here directly from a key part of the ACP’s Ethics Manual.

Bear in mind that before it ever saw the light of day, the Ethics Manual received extremely close scrutiny. The Ethics Manual is a document whose every syllable has gone through numerous and careful edits and revisions, by many well-educated experts. And experts on ethics, out of all the multitudes of wordsmiths residing in the academy, are the most careful and precise with their choice of words. The use of “parsimonious” was not an error, nor could it have been a subliminal choice. Like every other word in the Ethics Manual, “parsimonious” was very carefully considered, and was specifically chosen for its precise meaning. And therefore we can only conclude that what the ACP ethicists mean when they urge parsimonious care is: parsimonious care.

And most assuredly, parsimonious does not mean merely “efficient.” Indeed, the carefully-engineered sentence in which this word appears tells us that, while “parsimonious care” certainly encompasses efficiency, it’s something more than just efficient care. Efficient care is to parsimonious care as fondness is to lust; as a gentle spring rain is to a deadly deluge. “Parsimonious” crosses that line which converts a virtue to a vice.

So yes, the ACP Ethics Manual exhorts physicians to efficient care; but also to something well beyond just efficient care – to parsimonious care. To miserly care; to penurious care; to grasping, tight, close, niggardly, illiberal, mean, avaricious, covetous and tight-assed care.

But, of course, only for the benefit of society as a whole.

Now, if we were actually engaging in a debate (which of course, he recognizes, we are not), DrRich would smugly turn to his opponent at this point and make the following summation: “Since the ‘parsimonious care’ you champion is quite consistent with the new Social Justice mandate as interpreted by me (i.e., a mandate to ration healthcare at the bedside), but not so much with the Social Justice mandate as interpreted by you (i.e., a mandate only to be efficient), I rest my case.” (Note: DrRich is courteous enough not to refer to himself in the third person when engaged in a one-on-one exchange, as that would seem impolite and arrogant.)

Then, DrRich would simply end this post, and wait for the ACP (presumably this time in consultation with the Chair of the ACP’s Center for Lexicography) to attempt painfully to assemble some sort of rebuttal.


DrRich has updated his commentary on medical parsimony, in light of the newly-published Sixth Edition of the ACP Ethics Manual, here.

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