C.L. Gray: Is Obamacare the end of Hippocratic medicine?
By: C.L. Gray
Op-Ed Contributor
November 6, 2009
Strangely absent from today's health care debate is a discussion of the patient/physician relationship. This is remarkable. We may soon witness the end of Hippocratic medicine in America.
As I neared the end of my medical training in the late 1990s, the words of Peter Singer, Princeton University's chairman of bioethics, haunted me. In his book, "Rethinking Life and Death," Singer stated:
"There remains, however, the problem of the lack of any clear boundary between the newborn infant, who is clearly not a person in the ethically relevant sense, and the young child, who is." In our book, "Should the Baby Live?", my colleague Helga Kuhse and I suggested that a period of 28 days after birth might be allowed before the infant is accepted as having the same right to life as others. This is clearly before the infant could have a sense of its own existence over time, and would allow a couple to decide that it is better not to continue with a life that has begun very badly.
With three sentences, Singer turned medical ethics upside down. He suggested America adopt infanticide to control the skyrocketing cost of health care. By withholding care from children with disabilities (killing them is cheaper than treating them), Singer sacrificed the well-being of the individual patient for the "public good."
To understand how a leading bioethicist reached this horrific conclusion, I scoured the pages of history. Patterns emerged revealing the unseen hinge upon which today's health care debate turns.
For 2,500 years physicians have followed one of two possible paths. On one side, physicians make decisions to advance the good of society; their primary job is to protect the welfare of the state. On the other side, physicians devote themselves to the well-being of the individual citizen.
In his "Republic," Plato outlined the first position:
"... but bodies which disease had penetrated through and through [the physician] would not have attempted to cure ... he did not want to lengthen out good-for-nothing lives, or to have weak fathers begetting weaker sons; -- if a man was not able to live in the ordinary way [the physician] had no business to cure him; for such a cure would have been of no use either to himself, or to the state." (emphasis added)
Hippocrates countered with revolutionary perspective. He placed the patient at the center of medicine. With one timeless axiom he guided Hippocratic physicians for the next 2,000 years: "Primum non nocere" -- First, do no harm. When doctors enter the medical field they take an oath named after him.
Medicine remains one of society's most trusted professions. The almost sacred relationship between patients and their physician has marked the cornerstone of Hippocratic medicine. Patients want to see a physician they trust. Patients want to know their physician is looking out for their well-being -- not the financial interests of the state.
Government compassion sounds so noble. But under the weight of the exploding American debt, Washington will inevitably pressure physicians to constrain health care spending by limiting care. Even now Congress intends to cut Medicare by $400 billion. Drafted legislation penalizes physicians financially if they find themselves in the top 10 percent of health care spending.
Every American should have access to quality health care. But as government gains control over health care dollars, physicians increasingly become employees of the state. In the end, their loyalties conflict and patient care suffers.
We can control the cost of health care without strengthening the powerful grip of Washington. Physicians for Reform offers such a patient-centered plan.
So the question remains: Who will we follow? Plato or Hippocrates?
C.L. Gray is president of Physicians for Reform.
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