Human Exceptionalism

MDs Serving “Society” Aren’t Professionals

This isn’t good. Apparently, some medical societies are buying into the distrust sowing meme that doctors should give better care to some patients than to others.

Why? Duty to society. From the New York Times story:

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

No! Doctors are fiduciaries of each individual patient. They owe each patient the highest duty of care. They don’t owe a fiduciary duty to “society.”

Take that away, and doctors are no longer professionals, but technicians.

Making matters worse, some advocate that doctors threat different patients differently based on invidious “quality of life” discrimination:

The cardiology societies, for instance, plan for now to rely on published literature, not commission their own cost-effectiveness studies, said Dr. Paul A. Heidenreich, a professor at Stanford and co-chairman of the committee that wrote the new policy. They plan to rate the value of treatments based on the cost per quality-adjusted life-year, or QALY — a method used in Britain and by many health economists.

The societies say that treatments costing less than about $50,000 a QALY would be rated as high value, while those costing more than $150,000 a QALY would be low value. “We couldn’t go on just ignoring costs,” Dr. Heidenreich said.

QALY is a method of health care rationing in which the cost effectiveness of the same treatment is judged differently for different people based on the quality of their lives. 

I love the smell of lawsuits in the morning. We in the USA won’t accept providing optimal care to one patient and less to another based on the doctor’s (or bureaucrats’) belief in the supposed differing values of the respective patients’ lives.

I’m all for good medical stewardship. But doctors can’t serve two masters–their patients and the perceived needs of society. Hippocrates knew that 2500 years go.

So did the great German doctor, Christof Wilhelm Hufeland, who famously warned: “It is not up to [the doctor] whether life is happy or unhappy, worthwhile or not, and should he incorporate these perspectives into his trade the doctor could well become the most dangerous person in the state.”

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