Two Opposing “Moral” Orders: Who to Respond to?

Two Opposing “Moral” Orders: Who to Respond to?

        In The Medical Profession As A Moral Community, Pellegrino argues that a main dilemma of professional ethics that the physician faces is “an unenviable choice between two opposing moral orders, one based in the primacy of our ethical obligations to the sick, the other in the primacy of self-interest and the marketplace” (Pellegrino 221). To clarify, physicians are forced to choose between focusing on aiding sick individuals versus helping benefit the marketplace, which can be more or less looked at as the debate between beneficence and self-interest. I believe that physicians should focus on the ethical obligations of the sick, both because pursuing an act of self-interest is immoral and is not always noticeable in the grand scheme of things.

        What would a moral order be comprised of? In my opinion, a moral order would have to originate from a moral community, whose “members are bound to each other by a set of commonly held ethical commitments and whose purpose is something other than mere self-interest” (Pellegrino 225). If conforming to the character of the market “legitimates self-interest over beneficence and makes vices out of most of our traditional virtues” then how could it be moral? (Pellegrino 221). We could further argue the statement that, “medicine is at the heart a moral enterprise and those who practice it are de facto members of a moral community” (Pellegrino 222). Yes, medicine is intended to be moral but the focus can vary from self-interest to beneficence; hence, this does not ensure that a moral community exists or that moral enterprise is taking place. Similarly, when physicians speak about medical procedures, we cannot to prove they are acting in any way besides their self-interests, also showing that medicine does not guarantee morality.

Another good reason to stand firm on the belief that being a physician imposes certain necessities that impede turning ourselves primarily to entrepreneurs or businessmen is that individual aid is seen on an individual level; whereas acts reflecting the economic policy may go unnoticed.  If an individual was aided economically in disease-treatment, beneficence is much more prevalent than if an economic policy arose that attempted to increase health for all, but truly did not make an impact. Since, beneficence is defined as, “an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation,” responding to those in need is clearly moral. (Kisinger 44).

In conclusion, the ethical obligations to the sick should take precedence in the “who to respond to” debate, because of one: the morality associated with helping those in need and two: the concept of making a difference in an individual’s life. Business-like, fiscal behavior can be understandable for economic reasons during times of deficits; however, when we look at the larger picture, beneficence and morality represent what medicine should consist of.

Works Cited:

1.) Kisinger, Frank Stuart. “Beneficence and the Professional’s Moral Imperative.” NCBI. N.p., Dec. 2009. Web. 19 Apr. 2014. <>

2.) Pellegrino, Edmund D. “The Medical Profession As A Moral Community.” N.p., May 1990. Web. 19 Apr.2014.

3 thoughts on “Two Opposing “Moral” Orders: Who to Respond to?

  1. I agree that the moral obligation of beneficence and non-maleficence should take precedence over self-interest in the medical world, but how do we make this happen? People, doctors included, have to be self-interested at times. Survival requires it. Doctor’s have to be concerned about making money for themselves as well as for the place they work so that it can remain open and they can remain employed. The doctor is a “patient” as well at times and their well-being needs to be attended to as well. So, how do we make it so that the patient can always come first? I think changes to the system need to be made so that doctors don’t have to choose between self-interest and their patients? Because attending to self interest is the rational decision to make. So we need to eliminate the need to make the decision in the first place. How do we do this? Eliminate doctor’s med school loans? Maybe. I don’t know…

  2. While I agree that physicians should put the moral obligation of beneficence before self-interest, I think, realistically, that is a lot to ask from a doctor. Considering the circumstances of our medical system today, it can be extremely hard for doctors to put beneficence before self-interest. For instance, physicians face a lot of debt due to the high costs of medical school. It may take years to pay off that debt. A friend of mine recently got accepted into medical school and he predicted that he will still paying off his debts when he’s in his late-30s. In that case, it’s completely rational for doctors to choose self-interest over beneficence. They need to pay off their debt so that they can (hopefully) concentrate more on the patients. We should not put so much responsibility on the doctors, especially over things out of their control. Some people go into the profession knowing that they will be in a lot of debt afterwards, but they still do it because they want to help and treat the sick.

  3. Similarly, when physicians speak about medical procedures, we cannot to prove they are acting in any way besides their self-interests, also showing that medicine does not guarantee morality.

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