They're ethicists so they can be dismissed rather quickly. Tomorrow they are just as likely to be arguing there should be no abortion at all if you can't abort newborns. Yet there is growing concern that the government doing more things for more people in the best interests of overall society is leading to a resurgence in the social authoritarian rationalizations that gripped the country (and really, the world) the last time progressives held any power.
You've probably heard the name Oliver Wendell Holmes. He was a Supreme Court Justice, the son of a doctor and poet. If you have seen the phrase "clear and present danger" regarding freedom of speech and the example of "falsely shouting fire in a theatre and causing a panic", that is him. Republican Teddy Roosevelt nominated Holmes because they were both progressives - but they turned out to be very different kinds.
Unlike most prior Supreme Court justices, Holmes didn't subscribe to any personal sense of morality - he instead subscribed to legal positivism, the idea that there is no connection between law and morality. Or ethics. Or even logical formalism. Given that, and his belief in progressive principles, he found one social authoritarian progressive policy, eugenics, completely acceptable. One young woman, Carrie Buck, he called the “probable potential parent of socially inadequate offspring, likewise afflicted” and stated that “her welfare and that of society will be promoted by her sterilization” - because she had been raped at 17 and got pregnant. Actually, Holmes did not buy that she had been raped at all. It was believed by some that her mother had been institutionalized for being "promiscuous" and eugenics theory said young Carrie was likely promiscuous also - I know it sounds bizarre to most of a literate audience today but some people outside the reality-based science community also claim you can physically inherit voting from your parents, so progressive looniness is not just some old-timey phenomenon.
Given those things Holmes said, "It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough."
Shocking words, but that sentiment got him a government stamp in his honor and a Hollywood movie about his life. Those beliefs may also be coming back, worry some doctors. In a world where the government has to pay for metabolic diseases you may get if you get fat, why wouldn't modern progressives feel like they have a legitimate reason to ban Happy Meals?
Should the Patient Protection and Affordable Care Act (Obamacare to detractors) survive in the Supreme Court, 15 presidentially-appointed members on Independent Payment Advisory Board (IPAB) will determine what doctors can do and still be covered by Medicare. This IPAB is not subject to any Congressional oversight.
Creepy, right? Not to all because it is gradually becoming the system that is in place. Old doctors will balk but young ones are being suitably indoctrinated from the outset. The Centers for Medicare and Medicaid Services (CMS) has already instituted protocols for physicians to follow, including things that aren't shown to be any benefit, like pre-operative antibiotics for surgery. They penalize hospitals that don't comply with their guidelines, meaning they aren't going to get paid. How long will young doctors be able to withstand that pressure?
Medicine went from quackery before 1850 to terrific - but new rules may turn doctors into veterinarians. Photo: Shutterstock
It's more than monetary, it's also cultural. Since doctors are now in a 'teach to the protocol' environment controlled by the government, notes Dr. Jeffrey A. Singer, a Fellow of the American College of Surgeons, younger doctors will be less likely to buck new government rules in the best interests of patients, or even to have any creative thought at all. If a highly accomplished group created those guidelines, doctors taught to accept science and reason and expertise are not going to question them, even when it leads to cookie-cutter medicine.
Like science, medicine requires intellectual freedom. Unfortunately, there are persistent efforts to squash intellectual freedom for both of those fields.
Singer is no conservative crank, he was a key person behind passage of the Arizona Health Care Freedom Act and is treasurer of the US Health Freedom Coalition, which pushed for doctor and patient freedom of choice (*gasp*) in health care decisions - true liberalism, something everyone claims to believe in. Obviously, there was once a concern that insurance companies were the worst thing that could happen to doctors and the freedom to do good medicine. Yet a doctor with 30 years of experience in private practice and patient advocacy has already seen enough changes to believe what is coming is not better for patients than HMOs, it is worse.
Being told what to do in medicine by a court or the government healthwise is no different than what insurance companies do now, right? Of course it is. If a private company sends you a bill and you do not owe the money, you have a recourse. If the IRS sends you a bill and you do not owe the money, they put a lien on your bank account. And so the decisions of the government regarding medical care are much different than the decisions of an insurance company because there is no fallback position, like there is now. Today, a doctor and a hospital can undertake to use a treatment for the benefit of a patient and simply not get paid - if the government makes the rules, the government can and will put people in jail. While the best fix for society and health costs would be tort reform and therefore a reduction in the costs of defensive medicine, a right to sue will always be an important protection. You never hear about soldiers suing the government for a botched medical treatment - they legally cannot.
Limiting doctors may also lead to 'ethical' cancer - your general physician may start to think less like a follower of the Hippocratic Oath and more like a veterinarian. That isn't good for society - advancements are made by taking risks, not practicing overpriced defensive medicine and handing doctors a checklist of protocols they must obey regardless of what their experience shows.
Older doctors are a rebellious, cranky lot, even the ones who came of age during the era of Big Insurance - they won't react favorably to another layer of rules. We have to hope younger ones are inspired by doctors of the past 150 years and will balk at being ethical puppets of the latest cultural whims. Just because the government makes it legal and possible and even encourages doctors to act more like veterinarians doesn't mean they will.
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