Jewish World Review March 1, 2002 / 16 Adar, 5762

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports

Is new Hippocratic Oath hypocritical? -- HIPPOCRATES was a Greek physician. His name graces the Hippocratic Oath that, among other things, obliges doctors to "do no harm" and to place the patient's welfare before their own. "Hupokritos" was the Greek word for "actor." Our English term "hypocrite" derives from it.

That said, we introduce you to the "Medical Professionalism Project," an international group of physicians and others that recently published -- in the AMA Annals of Internal Medicine and the British journal Lancet -- "Medical Professionalism in the New Millenium: a Physician Charter." As to whether this product of their collective wisdom may be described as Hippocratic or hypocritical well, hypocrisy has been described as the tribute vice pays to virtue.

The Charter's premises seem virtuous enough. It defines the doctor's role as "placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing advice to society on matters of health." No problems there. The Charter then asserts the fundamental guiding principles should be "primacy of patients' welfare," "patients' autonomy," and "social justice."

Now, two outa three ain't bad. But the final item, social justice -- a nebulous, high-sounding phrase that the Left drags around to justify almost anything they care to advocate or undertake -- points to a set of "reforms" (another all-purpose obfuscation) far more hypocritical than Hippocratic.

In this document, social justice seems to mean two things, neither properly reasoned out and in many ways mutually exclusive.

The Charter speaks of the need to "reduce barriers to equitable health care." Why health care has to be equitable -- should everybody receive the same treatments? -- eludes us, but we press on. Whence cometh these "barriers"? From poverty, certainly. That's why, prior to the present era, doctors did charity work and lowered their fees as a matter of routine professional obligation and personal fulfillment. But today, the greatest barriers are institutional. One is an imploding employment-based health insurance system. Another is the HMO system, a bizarre perversion of capitalism in which money is made by withholding goods and services. And yet another is the government, which bureaucratically rations and denies care in a manner best described as "Franz Kafka Meets Alice in Wonderland."

And which is always on the verge of going broke.

If the MPM boys and girls really want to lower barriers, they might consider returning real power to both halves of the patient-doctor relationship.

Not likely. For the Charter states:

"While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources. . . . The physician's professional responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures because this "diminishes the resources available for others."

An obvious question arises. How is a physician to know what is or isn't available for "others"? Who are these others? Are they out in the physician's waiting room, or three thousand miles away? And who is to tell the physician what is or is not in short supply, beyond the scope of his or her own practice? The government? The insurance companies? The HMOs? We've had a half century's worth of experience in how they make these decisions, and the welfare of the patient -- or the doctor -- never seems high on their list of priorities.

And yet another question arises. Why should there be chronic scarcity of health care at all? In a market system, when people want more of something, they usually get it. There is no inherent reason why the health care system cannot deliver medical abundance, save for the manufacture of scarcity via organizations and institutions whose agendas, be their getting rich or getting re-elected, always seem to trump the free and proper practice of medicine.

Finally, this new breed of medical professionals would have a "commitment to honesty with patients" when errors or accidents occur, the better to preserve 'patients' trust." No quarrels there. But the Charter also speaks of "societal trust" based on "reporting and analyzing medical mistakes" to provide "the basis for appropriate prevention and improvement strategies." Strategies strategized by whom, and toward what economic, legal, and political ends?

So once again, we find ourselves offered a spurious "social justice" based upon rectifying inequities that the reformers themselves have created and still countenance. Not a bad definition of hypocrisy in action.

As for Hippocrates: he understood very well that social justice in medicine is best achieved one patient at a time, in the privacy and autonomy of a unique relationship. And he would no doubt have agreed that letting governments, corporations, and miasmic humanitarians dictate the terms of that relationship would violate his Oath.

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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© 2001, Michael A. Glueck & Robert J. Cihak