Thursday, April 16, 2009

Social Justice On Edge

Rosemary Flanigan
April 16, 2009

John Carney sent to several of us here at the Center a recent article in the Journal of the American Medical Association April 8), “The Ethical Foundation of American Medicine.”

The co-authors, one of whom is a physician, contend that the mantra of the BIG FOUR (beneficence, nonmaleficence, respect for autonomy and justice) have become unbalanced: “In a market-driven environment, fiscal independence seems to have become as important as autonomous decision making in practice, and concomitantly, attention to social justice may be decreased.”

Yes, yes, that’s been said before and if Kathleen Sibelius ever gets confirmed, she is going to have to do something about reimbursement patterns for Medicare and Medicaid, for instance.But the point that jarred me was this one: “. . .the percentage of Americans who agree that the higher the income, the more the individual should expect to pay in taxes to cover the cost of care for individuals who are less well off decreased from 66% in 1991 to 51% in 2003 and to 39% in 2006.”

Can you imagine even thinking about healthcare reform within this troubling trend—a trend that does not appear to be as pronounced in other westernized countries.The whole social justice issue stands tottering in the worlds of providers and receivers of healthcare. Maybe our former next-door-state-governor ought to hope she doesn’t get confirmed!

What a challenge.

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Blogger Practical Bioethics said...

It may be reasonable to move from the statistic to an assumption about underlying attitudinal trends: e.g., fewer respondents wanting higher taxes for public insurance correlates to lesser concern for justice.

However, aren't there other possible explanations? Perhaps the statistic indicates instead a popular belief that the solution to better healthcare for more of us isn't necessarily more tax dollars and increased spending but smarter and fairer use of available resources.

It might be that we are becoming as a society more selfish, less just; but I am not convinced of that--especially not on grounds of this survey data.

The election of a president who speaks of social justice, and acts justly, gives evidence of something else, perhaps. The solidarity values I see expressed via community service and other commendable lifestyle choices of my children, and many others of their generation, provides me with anecdotal evidence anyway of a potential trend away from crass individualist values.

Most of the med students and residents I encounter seem not to be in it for material rewards, and are morally aware and distressed by any perceptible loss of their own compassion.

All of this gives me hope.


Tarris Rosell, PhD, DMin
Center for Practical Bioethics
Central Baptist Seminary
(913) 909-3863

Thursday, April 16, 2009  
Blogger Practical Bioethics said...

Terry's comments certainly reflect my observations regarding medical students and younger physicians.

I spend each day with residents and medical students, and currently have two children in medical school myself. I am continually surprised, and pleased that many trainees are far more interested in the service they will provide than the compensation they may receive.

I do think our Society embraces stewardship to a greater degree than we often read about in the media. I remain optimistic, and I am glad to hear Terry does as well.

The complex issues surrounding health care are driven by many different reasons. Technology, managed care, pharmaceutical development, regulatory issues, etc.

I don't think it is related to lack of a commitment to social justice among our young trainees.

John D. Yeast, M.D., M.S.P.H.
Vice President of Medical Affairs
Saint Luke's Hospital of Kansas City

Thursday, April 16, 2009  
Blogger Practical Bioethics said...


I write at the risk of supplying some of you fodder for a humorous return email.

Dr. Yeast and Terry Rosell describe a refreshing, hopeful positive attitude in medical students. I find that same attitude in our law students – young people looking for ways to serve society, focused on the nature of fairness and justice on which many of us believe the law is built.

Which is pretty cool.

William H. Colby
Senior Fellow, Law and Patient Rights
Center for Practical Bioethics
1111 Main Street, Suite 500
Kansas City, MO 64105-2116

Thursday, April 16, 2009  

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