Of healthcare professionals, ethics, and strikes

Cambridge Quarterly of Healthcare Ethics

Volumn 9, Issue 4, 2000, Pages 513-520

  Loewy, Erich H ^a  

^a NONE

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[No Author keywords available]

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EID: 0034258430     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180100904092     Document Type: Article

References (10)

1. 1. The veil of ignorance that Rawls proposes is useful as a heuristic device. (See Rawls J. A Theory of Justice. Cambridge, Mass.: Harvard University Press, 1971.) There are, of course, problems with the use of this model, problems that have been discussed in various responses to Rawls. Here is not the place to review these arguments. Although the model hardly fully embraces the concept (the veil is too thick, the issue of justice is reduced to the summing of the choices of individual egotists choosing out of context with their community, etc.) it is useful in analyzing our particular values and ways of reasoning. A further analysis of this point can be found in Loewy EH. Moral Strangers, Moral Acquaintance, and Moral Friends: Connectedness and Its Conditions. Albany: State Univ. of New York Press, 1997.
2. 1. The veil of ignorance that Rawls proposes is useful as a heuristic device. (See Rawls J. A Theory of Justice. Cambridge, Mass.: Harvard University Press, 1971.) There are, of course, problems with the use of this model, problems that have been discussed in various responses to Rawls. Here is not the place to review these arguments. Although the model hardly fully embraces the concept (the veil is too thick, the issue of justice is reduced to the summing of the choices of individual egotists choosing out of context with their community, etc.) it is useful in analyzing our particular values and ways of reasoning. A further analysis of this point can be found in Loewy EH. Moral Strangers, Moral Acquaintance, and Moral Friends: Connectedness and Its Conditions. Albany: State Univ. of New York Press, 1997.
3. 2. The notion of using a homeostatic system to describe relationships between communal and individual interests can be found in Loewy EH. Freedom and Community: The Ethics of Interdependence. Albany: State Univ. of New York Press, 1994.
4. 3. Libertarians see nothing wrong with what amounts to the deprofessionalization of Healthcare professionals. To them, physicians and other healthcare workers are and by rights ought to be entrepreneurs. Indeed, to libertarians, medical morality can be seen as grounded in entrepreneurialism. (See Engelhardt HT. Morality for the medical-industrial complex: a code of ethics for the mass-marketing of healthcare. New England Journal of Medicine 1988;319(16):1086-9.) An emphatic contrary view is argued by Relman as well as Loewy. (See Relman A. Dealing with conflicts of interest. New England Journal of Medicine 1985;313(12):749-51 and Loewy EH. Of markets, technology, patients, and profit. Health Care Analysis 1994;2(2):101-10.) The language so current today of speaking of patients as "consumers" and healthcare professionals as "providers" unwittingly perhaps feeds into this. To consider a medical service as a "product line" - as I have heard internal medicine referred to - foresages the death of professionalism.
5. 3. Libertarians see nothing wrong with what amounts to the deprofessionalization of Healthcare professionals. To them, physicians and other healthcare workers are and by rights ought to be entrepreneurs. Indeed, to libertarians, medical morality can be seen as grounded in entrepreneurialism. (See Engelhardt HT. Morality for the medical-industrial complex: a code of ethics for the mass-marketing of healthcare. New England Journal of Medicine 1988;319(16):1086-9.) An emphatic contrary view is argued by Relman as well as Loewy. (See Relman A. Dealing with conflicts of interest. New England Journal of Medicine 1985;313(12):749-51 and Loewy EH. Of markets, technology, patients, and profit. Health Care Analysis 1994;2(2):101-10.) The language so current today of speaking of patients as "consumers" and healthcare professionals as "providers" unwittingly perhaps feeds into this. To consider a medical service as a "product line" - as I have heard internal medicine referred to - foresages the death of professionalism.
6. 3. Libertarians see nothing wrong with what amounts to the deprofessionalization of Healthcare professionals. To them, physicians and other healthcare workers are and by rights ought to be entrepreneurs. Indeed, to libertarians, medical morality can be seen as grounded in entrepreneurialism. (See Engelhardt HT. Morality for the medical-industrial complex: a code of ethics for the mass-marketing of healthcare. New England Journal of Medicine 1988;319(16):1086-9.) An emphatic contrary view is argued by Relman as well as Loewy. (See Relman A. Dealing with conflicts of interest. New England Journal of Medicine 1985;313(12):749-51 and Loewy EH. Of markets, technology, patients, and profit. Health Care Analysis 1994;2(2):101-10.) The language so current today of speaking of patients as "consumers" and healthcare professionals as "providers" unwittingly perhaps feeds into this. To consider a medical service as a "product line" - as I have heard internal medicine referred to - foresages the death of professionalism.
7. 4. The recognizition of "unidentified" lives as lives that are not in fact "unidentified" but merely not identified by ourselves and the way to deal with this problem is discussed more fully in Loewy EH. Moral Strangers, Moral Acquaintance, and Moral Friends: Connectedness and Its Conditions. Albany: State Univ. of New York Press, 1997 and in Loewy EH. The role of curiosity and imagination in ethics and medicine (forthcoming).
8. 4. The recognizition of "unidentified" lives as lives that are not in fact "unidentified" but merely not identified by ourselves and the way to deal with this problem is discussed more fully in Loewy EH. Moral Strangers, Moral Acquaintance, and Moral Friends: Connectedness and Its Conditions. Albany: State Univ. of New York Press, 1997 and in Loewy EH. The role of curiosity and imagination in ethics and medicine (forthcoming).
9. 5. Kant, of course, is the person who first articulated the ethical rule that one must never use others as well as oneself merely as means but always also as ends in themselves ("Handle so, daß du die Menschheit, sowohl in deiner Person, als in der Person eines jeden Anderen, jederzeit zugleich als Zweck, niemals bloß als Mittel brauchest"). This requirement specifically relates not only to others as persons but likewise to oneself: thus, the Kantian principle would frown as much on making oneself merely the means toward another's end (for example, by sacrificing everything to the good of one's patients) as it would on using others merely (the merely is critical) as the means toward one's own ends. See Kant I. Grundlegung zur Metaphysik der Sitten. In: Weischedel W, editor. Immanuel Kant: Werke, Band VIII. Frankfurt am Main: Suhrkamp Taschenbücher, 1974. (See esp. p. 61.)
10. 6. The organization of means in as efficient and humane a manner to serve a predetermined end is one of the key points throughout most of John Dewey's work. His view on strikes and on violence during strikes makes that very point in this context: even resorting to or at least threatening violence may, but only under highly unusual circumstances, represent such an efficiency and economy of means. See Dewey J. Progress. In: Boydston JA, editor. John Dewey: The Middle Works, Vol. 10. Carbondale: Southern Illinois University Press, 1985:234-41. (See esp. p. 247.)