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. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342811/>

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

Libertarian Paternalism: Helping Guide People in the Right Direction

Libertarian paternalism captures the combination of behavioral economics and paternalistic guidance.  Thaler and Sunstein define libertarian paternalism as guiding people to make an ideal decision without coercion or force.  A shortcoming of this concept is that many people falsely assume: 1.) there are viable alternatives to paternalism and 2.) paternalism always involves coercion (Thaler, Sunstein 386).  In the following paragraphs, I am going to refute these assumptions with demonstrations of necessary paternalism.

Firstly, libertarian paternalism can be well portrayed in the example created by Thaler and Sunstein in Behavioral Economics, Public Policy, And Paternalism: Libertarian Paternalism.  In summary, a cafeteria director realized that the order in which his food was arranged influenced consumer decisions.  So, what should the director do in order to change this problem?  This is when the concept of paternalism comes into play.  He could arrange the food so the healthiest options are more likely to be chosen, he could do the exact opposite, or he could choose randomly.  The director clearly has to make a choice here, so there are no other viable alternatives to paternalism.  Also, the director choosing the first option makes the consumers better off, without actually forcing any change in behavior (Thaler and Sunstein, 386).  Therefore, both false assumptions are not applicable to this situation.

Another example of libertarian paternalism is the program; Weight Watchers, which helps overweight people shed pounds and become healthier versions of them selves.  Occasionally, caring family members sign an unhealthy member up for Weight Watchers without their actual consent.  Does this constitute coercion or libertarian paternalism?  I believe signing up a family member in need does not constitute coercion, because they stand the right to refuse service and Weight Watchers would only make the subject better off.  If the subject is at risk for heart disease due to his/her obesity, then there are no viable alternatives and both false assumptions can be refuted yet again.

Finally, the concept of libertarian paternalism is directly correlated to many of the extreme medical dilemmas we have discussed in class.  For example, the earlier discussion of autonomous patients who are unsure if they want to proceed with treatment correlates to a physician’s usage of libertarian paternalism (Brody and Englehardt, 285).  Since the physician has the patient’s best interest in mind and cannot use coercion, (at least in fully autonomous situations) he might try to lead the patient in the most beneficial direction.  Also, when a patient is on his/her deathbed, there are normally no other viable options; therefore, disproving the false assumptions.

Overall, libertarian paternalism should not be immediately viewed as coercive and not allowing for individuality.  The previous three examples demonstrated a non-forceful, paternalistic approach with no other viable options; therefore, I think libertarian paternalism is necessary in many situations.

Works Cited:

1.)    Thaler, Richard H., and Cass R. Sunstein. “Behavioral Economics, Public Policy, And Paternalism: Libertarian Paternalism.” Arguing about Bioethics. By Stephen Holland. London: Routledge, 2012. 386. Print.

2.)    Brody, Baruch, and Tristram Englehardt. “ReservesDirect Login.” ReservesDirect Login. Prentice-Hall, 1987. Web. 24 Mar. 2014. <https://ereserves.library.emory.edu/reservesViewer.php?reserve=563720>. 285.

The concept of complexity of respect for personal autonomy is quite complicated.  Autonomy in medical ethics is defined as, “the ability of the person to make his or her own decisions” (Autonomy-Wikipedia).  Several questions such as which request to abide by, and how to know if a patient wants full or partial disclosure are entirely debatable.  In more instances than not patients change their minds regarding treatments, and this brings about the question of which request do we follow?  Childress questions, “Which choices and actions should we respect?  In particular is it justifiable to override a patient’s present autonomous choices and actions in the light of his/her past or (anticipated) future choices and actions?” (Childress, 310)  This is the key question I am going to address in my argument.

When it comes to present versus past or future autonomy, Childress believes that the present autonomous statement is the one to listen to.  I both agree and disagree with parts of this statement.  Firstly, if one is in an autonomous state of mind and is able to make his or her own decisions, then their present statements should be considered.  However, if one’s present autonomous requests completely contradict previous requests I think past autonomous opinions should be weighted more heavily.  As well exampled in Childress’s argument , a woman who has been courageous about her treatment all her life who suddenly decides she wants to stop treatment is acting out of character.  Although this is her present autonomous request, it should not be the end- all- be- all decision, because the authenticity is questionable.

Authenticity is another important concept regarding contradictory choices and is defined as, “an action is consistent with the attitudes, values, dispositions and life plans of the person” (Childress, 311).  As the previous example portrayed, the woman’s authenticity was not intact, because her new rash opinion entirely contradicted what she had previously believed.  Childress also argues that, “it would be a mistake to make authenticity a criterion of autonomy.  At most, actions apparently out of character and inauthentic can be caution flags that warn others to request explanations and justifications to determine whether the actions are autonomous” (Childress, 311).  This, I disagree with, because authenticity should be considered when a new judgment is inconsistent with previous ones.  If a new opinion harshly contradicts years worth of beliefs then wouldn’t it make sense to more heavily consider prior opinions?  Although this is very contradictory, an inauthentic statement should not change everything, it should mean little because long-standing opinions and beliefs more accurately represent one’s true stance.  Another important point brought about by Levi in Respecting Patient Autonomy is that, “..in many cases present autonomous decisions conflict with the interest of preserving or promoting future autonomy, and one must choose between the two.  This situation is perhaps most pressing when autonomous are greatly imprudent and likely to compromise future well-being in addition to autonomy” (Levi, 83).  This statement entirely supports my argument because usually the inauthentic, imprudent judgments of patients that are inconsistent with their character greatly compromises their future well-being.  Overall, I believe that past autonomous decisions that represent years worth of beliefs and opinions should be considered more heavily than rash, present autonomous decisions.

Interesting link regarding Doctors not respecting autonomy and pushing their own beliefs:

Sources:

1.)http://en.wikipedia.org/wiki/Autonomy

2.) Arguing About Bioethics- Holland

3.) Respecting Patient Autonomy- Levi

4.) Pressing Patients to Change Their Minds- Lerner