Medicine, A Moral Community

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In his essay “The Medical Profession as a Moral Community,” Pellegrino addresses the characteristics of a moral community:

  1. Members of the group share a covenantal relationship both with each other and with society.
  2. The community has certain standards that remain constant regardless of contemporary leaders or members.
  3. The community is more than the sum of all its members.

By this definition, the field of medicine can be considered a moral community.  The medical profession is more than each physician treating his or her respective patients.  The moral nature of the medical profession can actually be seen as completely necessary for the continued ethical function of the profession, given the vulnerability of patients.

 

Pellegrino describes the vulnerability of patients, and how this imposes even more of a need for doctors to remain moral as individuals and as a community.  In the not infrequent event of illness or disease, Pellegrino argues that the patient, no matter how self-sufficient they may be in other situations, becomes vulnerable in the medical setting. This inescapable vulnerability then creates a moral obligation for the physician.

 

This balance between beneficence and patient autonomy in a complex medical situation brings us back to what we discussed at the beginning of this semester.  While the physician has the obligation to “First, do no harm,” they must also, Pellegrino says, protect their patients against exploitation, which may include protection from the patient themselves or the physicians themselves.  One aspect of protecting the patient from themselves may be in the case of routine vaccination.

 

If physicians belong to a moral community that share a covenantal relationship with both each other and with society at large, then it would follow that they should support public health policies that protect the population majority.  One of these policies is mandatory vaccination.

 

While vaccinations are considered mandatory for children to attend public school, the majority of the states in the US allow both religious and philosophical exemptions, which allow parents to refuse vaccination on any terms.  If the medical profession is a moral community, then they have the obligation to protect their patients from the exploitation of the media with regards to anti-vaccination campaigns.

 

If physicians were to truly take a stand as moral agents in the medical profession, vaccination rates could possibly increase, which would decrease the number of outbreaks in communities, like the measles outbreaks which have gained attention recently.  If physicians were to make their case for vaccination instead of deferring to the opinions of uninformed parents, they might be able to make a difference.

 

Bibliography:

 

Pellegrino, Edmund (1990).  The Medical Profession as a Moral Community.  Bulletin of the New York Academy of Medicine. 66/3 221-232.

20 thoughts on “Medicine, A Moral Community”

  1. There is a lot of talk about incorporating health law advocacy into medical school curriculums for the reason you bring up- doctors don’t play a strong enough role as moral agents in their field. However, this is being improved little by little. For example, Georgetown Medical School is located in the most political area in the country- Washington D.C… Part of the medical school’s four-year curriculum includes advocacy for a health law. Future doctors become educated about how they can make a difference in the medical community. Georgetown emphasize their political role in health care reform. I think this should be a part of every medical school curriculum, because it’s possible that doctors can argue for the best possible laws for American Healthcare. Additionally, it helps doctors become very passionate about medical issues, which is how they should be.

  2. I understand the point regarding vaccinations but I do not know if I completely agree. Who is to judge weather that is the best decision for the doctor or the patient? If the patient has a strong religious belief against a vaccination – but the doctor believes it is right – isn’t it also his duty to protect and respect the patients views and ethics?

    Questions like this get complicated because it is hard to define what is rational for a group, and who’s rights and wants are more important. While be put a lot of pressure on the doctor to make the right moral decision, a patient would be incredibly unhappy if that moral decision if that did not align with the patients choice. Even more so, what if the patients choice is wrong but rational?

    This probably was not as coherent as I intended but I always find my mind running in circles with topics like these, because honestly who is to decide what is right?

  3. When looking at the community needs of healthcare, one idea that really stuck a chord with me regarded the supply of doctors. If we were to provide equal access to healthcare to everyone, there would be a significant increase needed in the doctor work force. In order to fulfill this need, new medical schools would either need to be established, or the current standards of medical schools would have to be lowered in order to accept more students. If either of these were to happens, there would be a dramatic increase in the number of doctors, yes, however there would also be a significant increase in sub-par doctors.
    How then would this impact the vulnerability of the patients?

  4. In class it was mentioned that if there were to be a moral community among the doctors then it would not be fair for patients. It was stated that it would be difficult to have the patients have a voice because it is more difficult to get them to be on the same page. The patient does become vulnerable especially in a medical setting. The doctor often times has more knowledge and experience working in medical practice, so it would make sense for them to be at a point of vulnerability. They can be told any information and would most likely believe the physician because of the amount of knowledge the patient expects them to have. Doctors are held to a very high standard probably because they are dealing with a life.

    You also stated that the vulnerability of the patients cause another moral obligation of the doctors. Due to the fact that patients are partially blind about certain treatments. So, the patient only has the information fed to them by their doctor. Unless the patient researches the treatment themselves, then they rely on the doctor to give them all of their information.

  5. Protection against exploitation—this is an interesting idea. Doctors do have power to protect their patients from certain types of exploitation, but what would be considered outside of their control? For example, financial exploitation: do doctors have any responsibility in that realm, if it is in the medical setting (the hospital billing the patient)?
    The other part I found interesting, and thought connected back to our discussion in class on Thursday, was your thoughts on vulnerability. Vulnerability is key; it distinguishes the difference between doctors being held to higher moral standards then businessmen. People expect salesman to have high self-interest, and therefore we are more hesitant and cautious when dealing with them. When in the presence of a doctor, I think people tend to expect that the doctor will do nothing other then what is best for them, the patient. Therefore we are much more trusting and vulnerable. In addition, freedom of choice is also related. Being hospitalized is not something people choose unless it is entirely necessary. Dealing with business people is more of a choice; it is not a matter of life or death. This difference highlights a reason for the differing degrees of vulnerability, and how vulnerability plays into our expectations of doctors’ morals.

  6. I agree with Ella’s comments on the importance of the concept of vulnerability. The patient vulnerability makes the relationship between the physician and patient unique, and it also confers a responsibility on the MDs. Thus, a doctor needs to be aware of this vulnerability as well as understand the power of their education. The moral community needs support and perpetuate the unique role of doctors in our society. Ella brings up another important point about exploitation. There is an interesting balance between the MD being a servant to the patient and the MD being an entrepreneur being paid for his or her services. Our system is currently caught in this debate with the issue of incentivized services for medical doctors and hospitals–the realization that doctors get paid the more they do leads to issues of over-treatment that is currently crippling our healthcare system. This situation relates back to the power of a medical degree, and the moral community of doctors need to find a balance between using this degree to help others, as well as support themselves. Or, more plainly, the medical community needs to find the balance between humanitarians and businessmen, and ethics should be the central influence on this community.

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