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.
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.