In The Medical Profession as a Moral Community, Pellegrino discusses the two opposing moral orders that the medical profession faces: their ethical obligations to the sick and their obligation to self-interest and the marketplace. There is no resolution to the two conflicting orders, and those in the medical profession are usually forced to choose one or the other. Today, that is exactly what we see happen in the medical community today. Physicians are often conflicted with their moral obligation to treat, care, and give patients the best possible options and their obligation to their own personal interests. Pellegrino already provides us a couple examples in his essay of how physicians protect their own interests, such as taking part in physician sponsored corporations, unions or strikes or refusing to see poor, Medicare, Medicaid, or AIDS patients (pg. 224).
The American Medical Association (AMA) is one of the largest associations of physicians in the United States. According to the AMA website, its mission is “to promote the art and science of medicine and the betterment of public health.” The AMA website also provides a list of past and current physician ethics that it uses to set standards for medical education. Some examples from the AMA’s 2001 version of Principals of Medical Ethics include:
- “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
- A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
- A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interest of the patient.
- A physician shall support access to medical care for all people.”
As you can see, many of the AMA medical ethics serve to protect the physician as well as the patients. However, I find this set of AMA medical ethics rather ironic. Historically, the AMA has been known to oppose any legislation that does not benefit the physician even though it benefits other people, such as universal healthcare. Many times throughout our history, some form of universal healthcare has been proposed but it has been opposed by the AMA, physicians, and insurance companies. Rather than acting in the interest of patients, physicians and leaders of the AMA have acted in self-interest. This very concerning since the AMA has a lot of influence over physicians and the government. No longer is medicine a moral community, but it is a community that acts in the self-interest.
Pellegrino proposes that American health care system needs moral leadership and medical statesmanship, and I completely agree. Associations, like the AMA, insurance companies, and the government currently have a lot of power over our health care. However, their interests are power and money, which is not what medicine and health care should be about. I have heard stories about physicians go into medical school with a moral obligation to help the sick. However, once they finish, their priorities change. They get trapped into this system created by the AMA, insurance companies, and the government. While they are not morally “bad,” sometimes physicians are forced to refuse patients on Medicare or Medicaid because they need to pay off their medical debts or have an obligation to the hospital. I think if our generation of future physicians is able to stand together as a moral community, change is possible. If everyone is going into the profession with a moral obligation to help the sick, we might have very different leaders serving at these powerful organizations and perhaps medicine can truly be a moral community.
Pellegrino, E. D. “The Medical Profession as a Moral Community.” Bulletin of the New York Academy of Medicine 66.3 (1990): 221-32. NCBI. Web. 20 Apr. 2014
244 thoughts on “Power of the AMA”
It is true that some of the actions that are taken by physicians may seem morally wrong. Turning people away from healthcare because of lack of insurance; refusing to give care to AIDS infected patients, sometimes refusing families or significant others to have their loved one’s autonomy, etc. However, I believe that many (NOT ALL) of these decisions have another side –there is more to the story.
The other side of the story is those that are telling the physicians to do all these things (or else). It is those that have a hold on the physician because they will decide if the physician will continue to have a job, whether the physician will get paid, or whether the physician will not be caught in legal issues. Most physicians spend their life in school in order to help people (the money they make is also a perk); however, they fall into a trap where they cannot control how they practice. They are subject to rules and restrictions that if they work against- they will fail. The essence of actual healthcare is moving away, and though it is not the physicians fault that is has begun to erode; it is the physicians’ fault for not trying to bring it back.
Physicians should band together to ensure that they healthcare is practiced the way they hoped, they way they felt best served the patients. In the end, it is the patients that count. And this needs to be reminded to many institutions involved in health care; however, one voice will not be able to stand against thousands of people. policies, regulations, and decade-long changes. Many voices of powerful physicians, however, can ultimately change healthcare.
I agree with Kimberly- not all the blame should be placed on the physician. Maybe it’s not feasible to accept Medicare or Medicaid patients, since the doctors don’t get paid enough for their time, or it could cause other issues such as taking up staff’s time, (for example, being on the phone with the insurance company trying to get the visit covered), which can detract from the ultimate goal of serving all patients. There are possible social issues that accompany patients covered by government insurance. I don’t think it’s fair to place all of the blame on one side. Physicians may be partly to blame, especially if they can afford the time to care for a patient when they know they won’t be paid as much. Of course, the AMA probably does have some corruption, just like any organization. They make strategic donations and influence health care law-making.
I agree with your point about insurance companies having a lot of power over our health. Insurance companies go to such great lengths to promote their products, taking physicians out to nice dinners, giving them tons of free products and samples, and showering them with gifts and baked goods. I have seen this first hand as my father is physician. Countless times he has brought home various gifts from insurance companies that are intended to encourage the physician to support a certain product. While such an extreme level of bribery is quite tempting, it is up to the physician to have the discretion and moral obligation to discount such bribes when making medical decisions. For example, i know my father would never promote a product that he didn’t feel was best for a patient, simply because he was being supplied with gifts. Therefore, while such bribery is clearly corrupt, it only becomes an issue when physicians get too wrapped up in the material possessions. A physician is a largely selfless career as one is devoting their life to bettering the lives of others. Thus, I would like to hope that the majority of physicians have the ability to adhere to their own ethics and good character to make appropriate decisions, despite coercive insurance companies.
When the question of moral responsibility came up in yesterday, many people countered that we demand too much out of physicians, that they cannot be expected to care for the patient and be an activist, as well as businessperson and confidant. I think there is something to say about burdening our medical professionals. Physicians aren’t superhuman and we have to stop treating them as such. What Pellegrino argues for, though, I don’t believe is impossible. The truth is, physicians are already activists in their own right. As this post mentions, the AMA organized against healthcare reform for years, many physicians wanted to maintain the system because it catered to their interests. I believe it is a matter of physicians standing up and fighting for their patients rather than self-interests that do nothing to accomplish the duty they agreed to take on in their oaths.
The medical profession is known for being one with a high salary, this is one of the things that justifies for people, the absurd amount of money it costs to go through medical school. Without the potential for a significant income after spending a huge amount of money on medical school, to many the path would seem impossible. Since medical school is the very beginning stage of becoming a doctor, it becomes clear that money has a substantial role from the beginning. Should we expect students to go into huge amounts of debt, and not provide a sufficient way to get out of it? This is impractical. But the money must come from somewhere, so it is logical that it would come from the people who are receiving the care—the patients. Here we get to the issue of dealing with patients immorally. The idea of implementing ethical leadership into medicine is an important one. But I also think that costs should be cut early on (lower tuition), which may provide an outlet for potential moral change in the system further down the line.
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Music video by Don Omar performing Salio El Sol. YouTube view counts pre-VEVO: 2,111,408. (C) 2006 Machete Music / VI Music
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