Tag Archives: physician ethics

A System Surviving on Self-Interest

Pellegrino makes a strong argument for our need for a moral community for doctors. In doing so he highlights the fine line faced in this profession between the ethical obligations to the sick vs. self-interest and the marketplace. As he continues his argument, he makes a clear argument for the former stating the moral and ethical obligations of a doctor to care for the sick over all else. While I morally agree with this statement, in the context of the United States I do not know that I buy this premise.

Pellegrino makes states a variety of examples of situations in which doctors would refuse patients saying, “we must feel demeaned by them and act to repudiate them” pushing for the Hippocratic oath as the ethical guide for doctors. While I completely agree that refusing to see a Medicare patient or patient with HIV is morally and ethically wrong – I want to also understand the other side of the story before agreeing to such absolute statements.

It is no shock that doctors are now making less money than they were before. Medical school costs having increased while pay has decreased leading to a significant number of doctors struggling to pay off student loans. In Escape Fire, the struggles of doctors to pay off current bills in order to stay in business are highlighted as a fault of the system. If doctors are paid by patients seen per day, it cannot be completely faulted on the doctor that slightly unethical practices (referring to the Hippocratic Oath regarding empathy) occur. Many practices are forced to fit in an increasing number of patients simply to stay in business – creating a culture of apathetic treatment as we have discussed many times in class. But is that really the fault of the doctor?

Speaking on patient rejecting, prior to Obama care a study in the Health Policy Journal Health Affairs found that 33% of primary care physicians were not accepting new Medicaid patients. Why? Low government reimbursement rates. Certain practices simply could not afford to stay in business while continually taking on new Medicaid patients while reimbursement rates were so low.

***Increasingly more ironic,  an economist with the CDC found that reimbursement rates were highest in states with high rates of physicians accepting Medicare.

Under Obama Care certain physical salaries will take a decrease depending on the federal decision to expand Medicaid. However, the doctor shortage will also be heightened leading to an increasing number of ethical concerns within Pellegrino’s quest for a moral community.

I do not condone much of the behavior that is being discussed. My position is rather that it is (in many cases) the fault of a system over the fault of a doctor. It is completely rational for a doctor to worry about paying his own bills vs. seeing one patient at times. Beyond Pellegrino’s moral community, I think we should be calling for greater government funding to offset the costs of medical school which will also allow for federal agencies to dictate specialties, etc that doctor’s choose to pursue. The change has to be more than just a call for morality, but true structural change.


Kliff, S. (2012, August 6). Study: One-third of doctors wouldn’t take new Medicaid patients last year. Washington Post. Retrieved , from http://www.washingtonpost.com

Matthews, M. (2013, November 25). When Will The Government Start Forcing Doctors To See Obamacare Patients?. Forbes. Retrieved , from http://www.forbes.com

Pellegrino, E. The medical profession as a moral community. PubMed66, 221-230.

Tyson, P. (2001, March 27). The Hippocratic Oath Today. PBS. Retrieved April 23, 2014, from http://www.pbs.org