The just war: For the health and wealth of our nation
There is an unjust war being waged in our healthcare establishment today.
It is an assault on medical ethics and empathy by the forces of corporate medicine - and the casualties of this war are unsuspecting patients and the idealistic young doctors who chose their profession for noble reasons.
It is, therefore, essential to the health and wealth of our nation to understand the source of this contentious war and draw the battle-line very clearly, if for nothing else for history's sake - because medical ethics and empathy are losing and with it the health and economic integrity of our healthcare establishment and nation.
Corporate medicine has as its primary objective the sustenance of a comfortable and profitable revenue stream.
Of course, its main tools are the vestments and slogans of patient safety, innovation, cutting-edge care, prominently trained clinicians, marketing honors and beautifully clean and luxurious hospitals buildings - these are all good things, or so they appear.
Medical ethics and empathy, on the other hand, are arcane, old, boring, abstract to the point of being almost theological - and, therefore, inaccessible to the vast majority of the public and even healthcare providers.
Some clinicians even see ethical arguments and empathy as "annoyances", "unfortunate complexities", or "idealistic not realistic" arguments that get in the way of "patient care" - code words in defense of corporate objectives.
Indeed, active awareness of the four principles of medical ethics requires real-life experience or diligent study - and empathy is a culturally instilled characteristic, not one that can be taught in medical school. So many of us, in this beautifully opulent society of ours, are deficient in a healthy stock of it.
We must recognize that the principles of medical ethics evolved over centuries of hard philosophical and theological engagement. And these are the irreplaceable spiritual foundation of the establishment we have inherited today - over-ride this foundation, and the entire system is sure to crumble.
We must fear that this override is fully underway in the year 2015.
The very serious trouble in our healthcare establishment today is that corporate medicine is where money and power have naturally aggregated. And when money is flowing, it is easy for the human mind and spirit to choose glossy corporate directives over the arcane and difficult ethical directive.
It is easy to choose money and power over principled ethics and well-reasoned medicine. When money and power are involved, it is easy to cast doubt and blow smoke over simple, but powerful and liberating truths.
It is such that in our healthcare establishment today the need for generating revenue and profit for our corporate entities in power can and does over-ride ethics - and with it, lost are the hard science and sound clinical acumen that built American medicine.
The age-old dictum remains true: money and power corrupt the human mind and spirit.
What are these principles of medical ethics that must now be defended in open warfare by ethical physicians, ethical corporate leaders, real patient advocates and our system of justice?
1) Beneficence: that the sole goal of treatment is to reverse the course of illness, suffering or death - or to improve the quality of his/her life.
2)
Non-maleficence
: that the treatment undertaken does not impose AVOIDABLE harm and that more effective and feasible treatments are not withheld for subjective reasons.
3) Justice: that the individual under care is treated away from rigid "assumptions" (scientific, clinical, social, or financial) that will do him/her injustice by withholding care, causing suffering, harm or death.
4) Autonomy: that the patient and his/her proxies have all the information about his/her condition to autonomously elect a treatment to reverse the course of illness or death.
These principles must never be compromised, by any practitioner of medicine or by any medical institution caring for INDIVIDUAL patients. All of them must be applied to the care of every INDIVIDUAL patient, every time.
And, very certainly, no single one of these arguments, in isolation, must be allowed to be hijacked by the forces of corporate medicine to justify its ends: revenue, volume, profits, hierarchy, order, and power.
But today, American corporate medicine is routinely over-riding medical ethics and empathy for the sick - forget about the poor, the disenfranchised, the uninsured, or the illegal alien.
It is doing so draped in academic regalia, in white coats, prestigious titles, and under the guise of committee and consensus. It is even permitted to "cherry-pick" the most favorable of ethical principles to make its arguments and meet its ends. And it is winning, almost definitively.
The casualties of this assault on medical ethics are the unsuspecting patients and families harmed, whose trust our medical establishment has earned over centuries of idealism in spirit and intellect.
The casualties of this assault on medical ethics are the young and idealistic physicians who will lose their profession's moral compass and burn out quickly - or worse, become no more than businessmen and women in suits.
Is it a wonder that recently doctors do not enjoy the societal esteem they used to?
Is it a wonder that many patients no longer trust us?
Is it a wonder that the "medical malpractice lawsuit" and our "outcomes rankings" are the parameters that many of us seem to worry about primarily– instead of passionately fighting our patients' illnesses?
The battle lines must be drawn before the soul of our establishment is killed.
Corporate medicine's objectives - at any level - must not be allowed to over ride the ethical foundation of our healthcare establishment: That is, the application of every one of the four core principles of ethics to every individual patient, every time, every minute, every day.
Very certainly, we must recognize and see the most powerful rhetorical weapons corporate medicine uses to over ride our ethical foundation when treating INDIVIDUAL patients:
1) Benefit of the Majority
2) Patient Choice
3) Medical Futility
They sound like reasonable concepts - but they are as malignant and occult as the most aggressive of cancers, to the health and care of individual patients.
And these three arguments are the very centerpiece weapons being used to assault our healthcare establishment's ethical foundation in the care of individual patients.
In the year 2015, corporate medicine is winning.
It is bleeding our health insurance industry to death. It is doing human damage by accepting AVOIDABLE harm to individual patients and by giving up on individual lives - when slivers of hope still remain and can be reached for. And it is killing the idealism that once moved the heart of the young doctor - all for short-term gains to the quarterly balance sheet.
The line is drawn in the sand - but who among us is strong enough to defend the truth?
Perhaps it is time for Thomas Aquinas' jus bellum iustum - to protect and to serve the sick, the suffering, and the disenfranchised. There are many we are failing.
Hooman Noorchashm and Amy Reed, husband-and-wife physicians, have campaigned to ban electric morcellators since December 2013, soon after Reed's unsuspected uterine cancer was spread by the device during a routine hysterectomy.
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