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.

          In defense of public health law, Lawrence O. Gostin argues for more spending on public health resources. He finds that over the course of history, society has promoted individualism at the expense of public health services (374). Gostin uses the recent threats of bioterrorism as a reason why we should be more concerned with introducing more stringent and uniform state and local public health laws. The article might have held even more weight had Gostin referenced the 1989 public health fiasco concerning the Reston virus. Today’s film industry seems to be in love with movie plots featuring deadly viruses that lead to quarantine and panic; however, these fictional tales we often see only in the movies do have some grounding in reality. Richard Preston, a writer for the New Yorker and best-selling novelist, knows all too well about the real possibility of viral outbreak in the U.S. In 1992, Preston published an article about the Reston virus scare, which originated in Reston, Virginia. The true story stems from disease research on primates. Monkeys are imported to the U.S. from all over the world and are lab testers for potential cures to deadly viruses. In 1989, a shipment of macaque monkeys was moved from the Philippines into the U.S., and strangely many of them began to die (62-65). After a series of misdiagnoses of what was affecting the monkeys, researchers came across a strain of Ebola that had never been seen before (73). This caused immediate panic within the facility as it was yet unknown how the discovered strain of Ebola would affect humans. Eventually it was found that while the virus was harmful to monkeys, it could not harm humans, though it can successfully reproduce in the human body (79). Overall though, Preston’s article shows the very real potential of fatal viruses making their way into the U.S.

          After the outbreak of the Reston virus, the Institute of Medicine published a paper about emerging infections and the growing threat of mutant bacteria (Preston, 80). Seeing how the Ebola virus and many other viruses cause fatalities worldwide should pressure the U.S. and individual states into taking greater care about health-scare preparedness. As Preston states in his article, “the presence of international airports puts every virus on earth within a day’s flying time of the U.S.” (62).  Just the existence of a potential for outbreak means we should be doing everything that we can to prevent it, as well as to prepare for it. As Gostin states in his piece, it is not about passing legislation that will necessarily work, but rather passing legislation that is stronger, better, and more effective than what we currently have (378).This means having to sacrifice some personal rights in the state of a public emergency. Without these precautions, we actually threaten the exercise of autonomy, as well as endanger human beings. So, it might be necessary to give up what we think of as individual rights in times of emergency, for the greater good of protecting future autonomy and individual rights.

Works Cited

Gostin, L.O. “Public Health Law in an Age of Terrorism: Rethinking Individual Rights and Common Goods.” Arguing About Bioethics. London: Routledge, 2012. 374-384. Print.

Preston, Richard. “Crisis in the Hot Zone.” The New Yorker. Oct. 26, 1992. 58-81.

          In his essay “Autonomy and the Refusal of Lifesaving Treatment”, Bruce Miller claims that the concept of autonomous persons requires physicians to put aside any of their values and opinions in an obligation to respect a patient’s wishes (22, 1981). We know that physicians are tasked with the duty to save people’s lives, which makes the perplexing cases Miller brings up rather troubling. Is a person’s autonomy more important than a physician’s obligation to save lives? Miller claims that autonomy has four “senses” we should consider in order to help us answer this question. One of the senses Miller evaluates is “autonomy as effective deliberation”. Autonomy in this sense, Miller claims, occurs when a patient has knowledge of risks, alternatives, etc. and weighs these possibilities rationally (24, 1981). Therefore, the patient is autonomous only by free action (i.e. the patient makes a voluntary choice). This makes case 3, a hard case to understand because the patient wants to have the right to die, even though the treatment does not seem to have any negative side effects from what we read in the passage. This seems highly irrational and MIller believes that in cases like this, the physician is obligated, at the very least to encourage the patient to make a decision that involves effective deliberation as well as authenticity (27, 1981).

          Miller claims that autonomy through effective deliberation is something that is protected by informed consent; the patient should know of the consequences and alternatives and then weighs and evaluates both to come to a logical decision(25, 1981). However, a disturbing case in Canada challenges the principles of autonomy in all of the senses that Miller identifies. A 46-year old man, Mann Kee Li was diagnosed with cancer, but wanted doctors to do everything in their power to save his life. WIth this in mind, physicians decided to order a “do not resuscitate” order upon Li. They argued that any further treatment or intervention would have no benefit to the patient. The hospital’s vice president claims that physicians are not obligated to provide treatment that offer no benefit. Although the doctors might not be able to do anything further to treat Li, an order of a DNR means that should Li’s life suddenly be threatened, doctors are legally obligated not to resuscitate him. It is one thing to question whether or not someone is making an effective deliberation about whether or not they should die rather than receive treatment, but I do not think we can question Li’s effective deliberation that his life is one worth living. One thing that cannot be denied is that a physician’s duty, first and foremost, is to do all they can to save someone’s life. We can argue that a person’s autonomy may or may not outrank this right, but when a patient tells a doctor not that he has a right to die, but that he has a right to live, it seems inhumane not to honor it.

Works CIted

Miller, Bruce L. “Autonomy & the Refusal of Lifesaving Treatment.” The Hastings Center Report. no. 4 (1981): 22-28.

Cribb, Robert. “Family, doctors battle over ‘do not resuscitate’ order.” The Toronto Star, , sec. Life: Health and Wellness, Oct. 25, 2010. http://www.thestar.com/life/health_wellness/2010/10/25/family_doctors_battle_over_do_not_resuscitate_order.html (accessed February 16, 2014).