Having advanced his theory of Progressivism, and having shown how his theory explains certain behaviors on the part of Progressives that otherwise might be difficult to explain, DrRich now proposes to examine the question of the medical ethics of Progressivism.
This ought to be an important question to doctors, patients, and anyone who thinks they might someday become a patient. For, however else one might want to define “ethics,” for practical purposes a system of ethics fundamentally determines how one ought to act when one must act in the face of competing interests. And the healthcare system being rife with competing interests, ethical guidance is critical as we determine who is to get what, when and how.
Because ethicists generally attempt to devise a solution which balances, to some degree, the various competing interests (which all tend to have at least some merit), the field of ethics has become very complex to the uninitiated. Indeed, the arguments ethicists use to justify their positions are frequently so difficult to follow that professional ethicists all too often have been reduced to a virtual priesthood, dispensing their lofty wisdom from on-high.
But since truly ethical behavior requires more than merely following handed-down marching orders, and indeed, requires a certain amount of clarity as regards ethical precepts, DrRich has always considered the arcane work-product being offered up by most modern ethicists to be, well, unethical.
And this is where Progressivism, for all its faults, provides a breath of fresh air. For the chief ethical precept of Progressivism is an item of exquisite clarity, a bright, shining beacon that cuts through all the fog and fuzziness, and points the way.
To review, Progressivism (in DrRich’s formulation, at least) is the idea that the driving imperative of mankind is to devise the perfect society, that, indeed, the desired “progress” in Progressivism is the steady advancement toward that perfect society. The Progressive program is the natural result of the belief, most famously espoused by Aristotle, that man is inherently a social animal, an animal that naturally forms into complex societies; that individual men and women do not have much intrinsic worth as stand-alone units, but only as components of their larger group.
Furthermore, the Progressive program is to be driven by an intellectual elite, who will determine what does and does not advance the perfect society. This requirement for an elite leadership also derives from Aristotle, who recognized that most individuals within a society are incapable of perceiving the greater good, and if left to their own devices would return mankind to the ranks of the apes.
The Progressive program of steadily advancing toward a perfect society is much more than merely a desirable goal, it is an imperative; it is intrinsic to humanity itself. All other programs (libertarianism, conservatism, religions which emphasize the importance of individual salvation, &c.) are not only counterproductive to man’s true imperative, but are heretical.
And so Progressive ethics, if nothing else, are crystal clear: Anything that advances the Progressive program is ethical; anything that hinders it is unethical.
This general statement of ethics immediately implies two corollaries that more directly define what “right behavior” will look like:
Corollary 1) What is best for the collective is best for the individual. That is, since individual humans only achieve their humanity as a part of the greater whole, it follows that the chief obligation of any individual within a society is to act for the good of the collective.
Corollary 2) Since what is best for the collective is determined by the intellectual elite, it is the obligation of all individuals in a society to follow that elite.
With this summary of Progressive ethics, let us now turn to the question of medical ethics.
Classical medical ethics, from the time of Hippocrates, required the physician to always use his/her special training and special capacity for autonomous action for the benefit of the individual patient, and to place the needs of the individual patient above their personal needs. This requirement is what defined medicine as a classical profession.*
* While the term “profession” has become diluted to include streetwalkers and football players, classically “the professions” were limited to physicians, lawyers and clergy, precisely because of this definition.
But classical medical ethics cannot be permitted under a Progressive program. Allowing (much less encouraging) physicians to act autonomously for the good of their individual patients will necessarily conflict with that which is best for the collective. This is true because if the needs of the individual were to prevail, then patients who are lucky, smart or rich, and who have doctors who are particularly clever or aggressive, will get more than their fair share of the healthcare resources, leaving the collective wanting.
Accordingly, after years and years of dogged work, the Progressive agenda has succeeded very recently in changing the formal definition of medical ethics. In early 2002, a “new charter” of medical ethics was published in the Annals of Internal Medicine. This new charter has since been formally endorsed by every major medical professional organization in the world. It charges physicians with the ethical obligation of achieving a fair distribution of healthcare resources. Medical students worldwide are now being taught that their main ethical obligation is to work for distributive justice, their obligation to work for the optimal benefit of their individual patients is a secondary concern, because of Corollary 1.
DrRich has described elsewhere how this new medical ethics places patients in great jeopardy, and wrecks medicine as a true profession. But old farts like DrRich (who prefers to think of himself as a “classic” physician), who still care about such things, will be gone in a few decades and can be safely ignored.
(For those who are interested, DrRich had the opportunity earlier this year to engage representatives of the American College of Physicians – chief authors of the New Ethics – in a public debate over medical ethics in this very space. DrRich was, at the end of the day, brushed off by the ACP, but not before eliciting a response from the Chair of the ACP’s Committee on Ethics, Professionalism, and Human Rights. That response, in essence, was, “What is good for the collective is good for the individual, and any jack-dog knows this. Who the hell are you?” In other words she invoked Corollary 1. You can read all the details about the great Medical Ethics Smack Down in this series of articles.)
One might ask, what was the impetus for physicians to voluntarily change their time-honored ethical precepts?
They were coerced.
Significant coercion was being applied to doctors to place the interests of the third party payers – both insurance companies and the government – ahead of their duty to individual patients. The utter impotence of physicians in fighting off this coercion was the impetus for promulgating the new ethical precept (to society) in the first place. This fact was stated explicitly in a 1998 article by Hall and Berenson in the Annals of Internal Medicine (volume 128, p 395) which stated: “It is untenable for the medical profession to continue asserting an idealistic ethic that is contradicted so openly in clinical practice. . .,” and which called for a “new ethic” which was more consistent with how doctors were being forced to behave. Specifically, the proposed “new ethic” was a duty to the group.
This paper was an important impetus to formally changing professional ethics. When the new ethical standard istelf was finally published in 2002, its very first sentence began, “Physicians today are experiencing frustration as changes in the health care delivery systems in virtually all industrialized countries threaten the very nature and values of medical professionalism.”
In other words, physicians felt powerless to fight off the coercion – so in response they changed medical ethics to make it OK to cave in.
And to say it yet another way, physicians can now act under Corollary 2 with a clear conscience.
Accordingly, it is now become the physician’s ethical obligation – and not merely a legal or regulatory obligation – to follow to the letter the guidelines, processes, and procedures that are handed down to them from various government-established expert panels, when they are caring for their patients. Autonomous actions taken on behalf of individual patients is more than just discouraged, it is, simply, wrong.
Under our new program of medical ethics, then, doctors are absolved of much of the responsibility of clinical decision-making. As many of those decisions as possible – a continually increasing quantity of them as time goes by – will be determined centrally, at which point the doctor is ethically obligated to follow them.
DrRich continues to think this new program is harmful to patients and to the medical profession. He will bring up some specific issues in this regard in future posts.