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The Silence of Ethics and the Economies of Medicine
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13156 |
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Section : |
MODERN THOUGHT
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| Issue
Date : |
11 / 1987 |
5,342 Words |
| Author
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Colleen D. Clements
Colleen D. Clements is assistant professor of psychiatry at
the University of Rochester Medical School. |
My fear is that the academics and theologians, with the best intentions, are being seduced into an unholy alliance with the many bean counters who oversee our hospitals, and will provide them with the aura of humanity and ethical sanction that only blurs what is the true state of American medicine: reduced services, and even denied services, to those who are in fact not "too far gone" to be saved, but only too old, too poor, or too powerless to command adequate care.
--Letter from a Colleague
Secular medical ethics was first articulated in the late 1950s and early 1960s by Joseph Fletcher and Paul Ramsey. Originally called "bioethics," this latest candidate for an academic specialty was seen as an intellectual alternative to Roman Catholic medical ethics with its long history and carefully worked out theoretical structure. Since those early days, the status of the proposed discipline has been partially indicated by the numerous name changes traced by Potter. Medical bioethics, medical ethics, biomedical ethics, values Potter. Medical bioethics, medical ethics, biomedical ethics, values in medicine, ethics and law, ethical, legal, and social issues in medicine, ethical guidelines, ethics committees, protocols--all signify the confusion and change that has occurred from the 1960s to the 1980s. Medical ethics may be characterized fairly as a number of actors in search of a play.
Some of those actors are playing parts that have been extensively rewritten since the 1950s. Those parts belong in a theoretical context, an unfinished play about ethical theory and axiology (theory of values) and the lack of both in applied medical ethics. Some of the conceptual problems in the field of ethics can explain the transition in medical ethics from medical care to medical law and economics. Finally, the problem of medical ethics-as-apologetics can be linked with the broad social context of cost containment in medicine. The actual consequences for patients caught in these changes within the medical system need to be stated clearly, and the silence of ethicists about the clinical results of their apologetics role should be broken.
An Ethic In Transition
When I entered the field of medical bioethics, I envisioned an interdiscipline of biology and ethics in the same model as the interdiscipline of molecular biology. At best this was a project for the future. My nine years at the medical school, first in the Division of Genetics and then in the
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