Medicine Besieged: The Supremacy of Pragmatism and the Acceptance of Situational Ethics

I found a great opinion piece written in 1997 by Miguel Faria, Jr.. It's entitled On the Moral Virtues and Evolving Professional Ethics: A Message to Physicians . Here is an excerpt (but go read the whole thing)

"Medical Ethics
Why is all of this relevant to the present plight of medicine? Because the ancient ethical foundations of medicine laid down by our predecessors from Hippocrates (460-370 BC) to Thomas Percival (1740-1804) and other physicians and genuine medical ethicists have been (and continue to be) greatly eroded by those masquerading as free-marketeers but in reality are constructing the scaffold of corporate socialized medicine.6 Contributing to this task are also many self-proclaimed, non-physician medical ethicists who provide the "moral" and "rational" basis for cost-containment and rationing in health care.7

These disparate groups (e.g., corporate elitists, collectivists, etc.), aided and abetted by entrenched bureaucrats in both the private and public sector, have unilaterally decided that health network megacorporations (motivated by the bottom line and using the capitalist engine for cost-containment and rationing) may, under the aegis of government authority, impose managed competition on the American people (those receiving) and on devoted physicians (those delivering) medical care in the trenches of the American heartland. That is, they want to make big profits at the expense of both, but to do so, they must first change the ethics of the noble profession of medicine. And to accomplish this goal, they must sell us the erroneous idea that medical ethics evolves with time and may be tailored to fit the needs of specific conditions, i.e. the present situation or the post-Modern age. It goes without saying that for medicine, the supremacy of pragmatism and the acceptance of situational ethics will further erode medicine's idealism and altruism, the patient-doctor relationship and the veritable transmogrification of the ancient Hippocratic ethic to a modern, convenient, alterable, cost-effective, veterinary ethic.

The ancient ethical foundations of medicine have been greatly eroded by those masquerading as free-marketeers who in reality are constructing the scaffold of corporate socialized medicine.


To combat this strong, treacherous current will take virtuous physicians, imbued not only with courage and moral fortitude, but also armed with the intellectual virtues — namely, understanding, knowledge, and wisdom — that are assiduously cultivated and nurtured by a lifelong commitment to learning, perseverance, and a devotion to principle, duty, and individual responsibility. The 2500-year-old beneficent ethics of the medical profession and Hippocratic medicine do not need changing into a new veterinary ethic of corporate socialized medicine to fit contemporary ethos — and satisfy corporate greed. Like universal truths, medical ethics should be considered (and should remain) constant and immutable, not subject to the political expediency of the moment — or the pragmatism of the collectivist central planners.

Given the formidable obstacles that lie ahead, "it will take truly Renaissance physicians of the highest order and courage to surmount the titanic hurdles in their path and repel the Vandal hordes massing for the final onslaught, eager to breach the gates, to pillage and plunder the traditional practice of medicine, and sap its substance."8

Yes, it will take intellectual virtues as well as moral courage to repel the sundry Vandals who seek to impose on the nation the veterinary ethic of managed care and corporate socialized medicine. As physicians, we must prevent the perversion of our time-honored ethics and the final dissolution of the sanctity of the patient-doctor relationship, while implementing the truly individually-based, patient-oriented free-market approach to medical care that is so desperately needed to derail the odious juggernaut of managed competition, a scheme that seeks to destroy the ethical practice of medicine — one of the great remaining legacies of Western civilization and the American way of life."

I would like to know how the professional medical ethicists are being trained. I doubt that, before managed care, hospitals employed such persons. Does anyone know?

Update:

Look at this quote from the piece above:

"It goes without saying that for medicine, the supremacy of pragmatism and the acceptance of situational ethics will further erode medicine's idealism and altruism, the patient-doctor relationship and the veritable transmogrification of the ancient Hippocratic ethic to a modern, convenient, alterable, cost-effective, veterinary ethic".

Until a moment ago, I didn't know what the bolded part meant. Now I do. From another piece by Dr. Faria:

"The alternative view represents corporate socialized medicine centered around the concept of managed care/HMOs, whereby bureaucrats dictate patient care from afar, claiming to rely on the false "ethics of caring," but in reality basing their policies on what is actually closer to the Swiss philosopher Ernest Truffer's veterinary ethics, an ethic that forces physicians to act in the interest of the corporate entity as third-party payer, rather than in the interest of their patients; mandates coercive compassion; responds only to pressure by politically-powerful special interests; and insists on statism and collectivism, rather than voluntary individual incentives."

The above comes from his piece entitled: Corporate Socialized Medicine Threatens Medical Profession also written in 1997. It's also a great read.