Market vs. Morals

Throughout the course of this semester, one of the major questions that often came up was about the role of physicians in patient care. What kind of obligations do they have? How does the role of being a doctor factor into the ethical dilemmas that often come up in medicine. Pellegrino gives us a pretty straightforward answer to that question. The role of a physician is a communal one; that is to say that the individual choices a physician makes should be for the greater good of the community. This goal is problematic in modern society however, because of the conflicting ethos of the marketplace. The ethos of the market is one that is concerned with profit as the primary goal, which unfortunately puts people on the backburner.

This toleration of treating people as a means to an end is directly opposed to morality. Philosopher Immanuel Kant explicates why we should not treat people as a means to an end in his Groundwork for the Metaphysics of Morals; each individual has moral autonomy– that is, their will can be guided by the question “what ought I do?” (107). This question should be answered by following what Kant refers to as the categorical imperative. The categorical imperative states that one should “act only in accordance with that maxim through which you can at the same time will that it become a universal law” (56). The ethos of the marketplace directly contradicts this because its goal is meant to benefit a small subset of people at the expense of others. Additionally, everyone has a duty to act in accordance with the moral law (Kant, 13). Thus, ideally physicians should always oppose the ethos of the market since it is not in the best interest of the greater community.

Pellegrino also gives us a good reasoning as to why we should believe that the moral duty of a physician is always to protect each individual patient. He mentions that gaining a medical education is a privilege in that it gives access to knowledge that is not readily available to those outside of the medical field (Pellegrino, 227). Thus, patients are vulnerable in that they are relying on the knowledge and skill of someone else because they do not possess the knowledge themselves. SInce the patient’s autonomy is at stake when they are sick, it then becomes the responsibility of the doctor to return them to a state of well-being. Pellegrino suggests that the way to go about de-profitizing medicine is to convince legal professionals that the medical field is being harmed by this profitization (230). While I agree with his reasoning here, I think we can take it even one step further. Since treating people as a means to an end is never moral in any case, we need to change the ethos of the marketplace altogether.  As long as the ethos of the market remains as it is, no industry can ever be safe from becoming or remaining privatized; so perhaps the solution is to make profit a secondary goal to protecting the right of people not being treated as means. The question then is, how exactly do we go about changing a value that seems so ingrained in our society.

Works Cited

Kant, Immanuel, and Allen W. Wood. Groundwork for the metaphysics of morals. New Haven: Yale University Press, 2002. Print.

Pellegrino, Edmund. “The Medical Profession as a Moral Community.” Bulletin of the New York Academy of Medicine 66 (3): 37-74. Print.

9 thoughts on “Market vs. Morals

  1. I agree that we don’t care enough about the individual’s outcome, because the doctor profits whether or not he gives the patient the best care possible. There is a missing link in here that makes it difficult to achieve the best quality of care. Doctors have to retake their exams every 10 years or so, and this ensures that they are still knowledgable. They have to do what is called “Continuing Medical Education,” which ensures their knowledge is up to date. However, there is little to no quality control in place to determine whether the doctor is compassionate and takes quality care of the patient. Profit cannot be a secondary goal for somebody who cares little about the “ethos” of medicine. The US is particularly bad at this, because we have a low satisfaction rate, whereas other countries have higher satisfaction rates with their healthcare system.

    Go to this link and scroll down to 3rd green/blue graph- “Satisfaction with the Healthcare System”:

  2. I agree with you completely and especially like your point that the marketplace’s “goal is meant to benefit a small subset of people at the expense of others.” Throughout this semester, I think that the ongoing theme was about the doctor’s responsibility for his patient in ethical terms. Like you argued, I think that the doctor does have a moral responsibility to treat his patient with the patient’s best interest in mind rather than focusing on the profit that the doctor may get by working alongside his marketplace. I have argued all along that I think it’s not necessarily the doctors that are to blame, but rather the medical system in general; or as you said it, the marketplace. The marketplace’s focus is to treat people as efficiently as possible by making the highest profit possible. I agree with you when you say that the focus on profit should definitely be secondary to the actual care for the patient. Again, though it’s easy to say this, I ask the same question as you: how can we alter the medical system when it’s been in tact for so many years?

  3. As a profession, physicians are held to higher moral standards and expectations than other careers. This is predominately due to the fact that they make a living off of helping people. However, one must consider that physicians are part of a business. All businesses exist within a marketplace that has its own expectations and standards. I think that as a society we must separate the physician’s moral responsibilities from that of the business. Jamila references Pellegrino’s suggestion that the medical field is placed at harm due to the end goal of gaining profit. I disagree. Many of the new technologies, treatments and procedures are discovered because physicians and researchers have the money to create them. Making the medical field less profitable would not only harm the medical field, but may harm the population as a whole. One can argue that the medical field and physicians are two different categories, but they are not. Doctors are more visible and tangible than the medical field as a whole, and are subject to more opinions and expectations, when in reality every profession within the medical field under the same marketplace.

  4. Throughout the semester, we’ve been placing a lot of emphasis on the responsibility of the doctor. As doctors, they have a moral responsibility to help people in an ethical way. However, that’s really hard to do because, unforunately, health care is a type of business. There’s a trade off; physicians offer their services to the patients, and patients are the consumers in the relationship. Physicians are human beings too, and while I’m not saying it’s morally right, physicians may not always put the patients before themselves, especially in a marketplace. Now that may be due to the flawed medical system that we have, forcing them to choose quantity over quality, or it can simply be because they’re seeking their own best interest. While the question of how to alter the system is important, I think asking what type of people are particularly suited for this profession is just as important, especially considering the current situation of our health care system. Like, what kind of people do we want going into this profession if we know that system does not give a lot of power to the patients?

  5. Making profit a secondary goal—sadly, for many, I think they would prefer this tactic, but it is not a realistic option. The market is about competition. Competition is necessary for success in the market place. For those who choose not to compete, for those who choose to make profit a secondary goal, they are left unsuccessful and no longer have the ability to make an impact or help the people they set out to help. This is a backwards situation: the people, who are in it for the work itself, for the soul purpose of helping patients, are pushed out. What ends up happening is that hospitals—those that are privately owned—are controlled by people who are not doctors, and as a result, the doctors do not have to be directly responsible for how the system may exploit the patient. As for the owners, should they be held to higher morality also? I think that they should. I think that anyone involved in the medical field should have morals at the forefront of whatever they are doing.

  6. While I agree that doctors should act morally and that this is harder to do within a marketplace environment, I do not think it is possible to get rid of the marketplace and instead should focus on how to improve morality in the system. Marketplaces have been used in most societies for centuries and are in a lot of ways necessary for large societies to function. Also I think it is important to realize that in a lot of situations it is not just the doctor using the patient for a means to an end, but the patient using the doctor as well. I don’t believe it is immoral for a doctor and patient to have an exchange without knowing much about one another if both parties are happy with the situation and it does not decrease the medical care (e.g. if a doctor sets and puts a patient’s broken arm into a cast). I believe the morality only comes into play when the patient wants more out of the doctor or is getting worse treatment due to the doctors desire for money over patient wellbeing.

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