Paul;
You bring up some interesting points in your discussion on medical =
ethics. I am not sure what you are referring to in the "two-hour =
discussion"; was that a private conversation, a television show, or =
what?
Any conversation that relates to medical ethics inevitably involves =
economics, as you are noting from your comments (asa-digest V1#32). =
Kilner has a particular approach that I appreciate, but his view has =
problems in that it makes some tacit and unexplained assumptions about =
medical economics that I disagree with (I disagree with other things =
that he says, but will discuss that another day).=20
The first assumption is that it is immoral to not provide basic health =
care to all citizens of a good community. Thus, the need for society to =
provide a basic form of health coverage to all of its citizens. It is =
assumed that denial of medical care for inability to pay is also =
immoral. Granted, I am one of the few doctors (Surgical Oncologist) in =
my community willing to treat anyone regardless of ability to pay, but I =
do make it clear that my services demand reimbursement similar to the =
reimbursement that a patient may expect to have to pay for any other =
service rendered to them, such as a haircut. Why are medical services =
any different?
You might argue that medical services are essential for life and =
health. Yet, so is food, shelter, and clothing, and I don't see a =
movement to guarantee the right of every citizen in the USA to a basic =
level of food, shelter, and clothing. Indeed, as M. Olasky pointed out =
(Crisis of American Compassion), our social programs to "help" the poor =
have often done more harm than good. The same applies to the rendering =
of medical care, where patients have not had to worry about paying for =
health care costs that may accrue from activities that are detrimental =
to their health.
Kilner argues in his book Life on the Line that rationing is imperative =
for American medicine to survive. He argued the same at the ASA national =
conference recently. Yet, his thinking is based on an outdated =
e choices, or of providing them "universal health care"? I say that it =
is the later. It is hard from your writing to tell what you are =
referring to as the irresponsibility.
I would refer you to the new AAPS journal "Medical Sentinel", or to the =
Journal of Biblical Ethics in Medicine for in depth discussion of issues =
of medical economics.=20
Paul, I raise these issues not to be devisive. It is difficult for a =
concerned physician to sit back and allow others determine our own =
destiny, and determine our "ethics" of the practice of medicine. If =
physicians did such a thing to scientists, engineers, or academicians, =
you would raise an eyebrow and question the source of the activity as =
making the ethical inquiry in part illigitimate. It is not that people =
from other areas of expertise help clarify issues, but I do resent when =
I hear people like Nigel deCameron of Trinity Evang. Sem. suggest that =
medical ethics is too important to leave into the hands of physicians.=20
Honestly, I'd love to hear what ASA members have to say regarding =
various issues in medical ethics. My offer remains open to help draw up =
a questionaire for the ASA. I hope you take my comments in the spirit of =
Christ's love, realizing that I may be a little "dicey" about such =
discussions, as such topics matter much to me, since I am not only a =
scientist but a practicing physician frequently involved in medical =
ethics issues.
Deus Vobiscum.
Kenneth A. Feucht, M.D., Ph.D., FACS
Good Samaritan Surgical Associates
1526 29th Pl SE
Puyallup, WA 98374
kenf@kenf.seanet.com
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