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Medical ethics is in "disarray" as for-profit health care has changed the landscape of American medicine and the reality of limited resources has seemed to undermine the physician's relationship to the individual patient.
So said Edmund Pellegrino, M.D., a professor of medicine and medical ethics at Georgetown University, at a conference last month sponsored by the Council of Medical Specialty Societies (CMSS) titled "Contemporary Health Care and the Ethic of Medicine: What Is a Physician to Do?"
His comments underscored the uneasiness expressed by speakers throughout the conference that a transformation of historical proportions has overtaken American medicine, leaving traditional ethical certainties open to question.
"We are in the midst of a serious moral malaise," Pellegrino told physicians at the three-day conference in Chicago. "As I look into the future, I think we will be a more divided profession than we are now. We will not again have an ethic which will bind us all.
"Just where we will depart will be an open question," he said.
Pellegrino said that in an era of "moral skepticism" in which all moral truths are assumed to be idiosyncratic, physicians nevertheless can reassert their moral foundations by standing by the doctor-patient relationship. It is this relationship, he said, that informs the moral identity of the medical profession.
Pellegrino urged courage in the face of forces that appear to threaten that relationship and suggested that the increasingly entrepreneurial atmosphere in American medicine is forcing a showdown.
"We cannot do the Pontius Pilate act," he said. "We cannot turn our back, wash our hands and say, 'He did it, not me,' or 'I did it because they forced me.'
"This means that in the managed care setting, there can only be one answer. I can't say, 'Sorry, you really shouldn't have this particular treatment, but I can't do anything about it.'"
Pellegrino added, "I think our profession is coming to a point in its history when it must say about certain things, 'We will not!' We will win no battles if we resort to our own prerogatives. [A]ll too often we have objected because something has been not in our self-interest. That's an indictment of us. . . rather than helping us to convince the public and our patients that managed care--or whatever it is that violates [professional ethics]--is something they should be concerned with, and not just a defense of our prerogatives."
The conference, organized by Sara Charles, M.D., APA representative to the CMSS and chair of its Task Force on the Ethic of the Profession, brought together representatives from 17 specialty societies.
Throughout the meeting work groups labored to develop a set of principles to guide physicians in three broad areas of ethical concern: the physician-patient relationship, the physician-physician relationship, and the relationship of the physician to society.
Leading the work group on the physician-patient relationship was psychiatrist David Wahl, M.D., vice chair of APA's Ethics Committee.
The work group principles, presented at the end of the meeting to the conferees, will be sent to all of the specialty societies within the CMSS--including APA--for review and revision.
Discussion of the work group statements at the conference was moderated by APA Assembly Speaker-elect Jeremy Lazarus, M.D., and APA Medical Director-designate Steven Mirin, M.D., in an effort to achieve consensus around ethical issues posed by changes in the health care market.
In addition to Pellegrino, Lazarus, Mirin, and Charles, speakers at last month's conference included Joseph J. Fins, M.D., director of medical ethics at New York Hospital; George D. Lundberg, M.D., editor of the Journal of the American Medical Association; and the Rev. James L. Connor, S.J., director of the Woodstock Theological Center at Georgetown University.
Also speaking were Christine Cassel, M.D., professor and chair of the department of geriatrics and adult development at Mt. Sinai Medical Center (see page 8), and the Rev. Monsignor Kenneth Velo, president of the Catholic Church Extension Society of the United States, who spoke on behalf of the late Joseph Cardinal Bernadin, S.J., archbishop of Chicago.
(Psychiatric News, May 16, 1997)