Individually-based Medical Ethics vs Population-based Bioethics (Summer 2002)



Author: Jerome C. Arnett, Jr., MD, FCCP
Article Type: Feature Article
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


An entire culture is unraveling because its underlying philosophy is defective. As a part of this philosophy, a new ethics has replaced our traditional medical ethics, and the core values of Western Civilization --- the worth of the individual and the sanctity of human life --- have been rejected, along with the tradition of Hippocrates, religious values, and the very idea of objective right and wrong. There is nothing special in being human, killing is beneficent, suicide is rational, and caring for the elderly is a burden that wastes our financial resources.(1) This is what Wesley J. Smith documents in his shocking book, Culture of Death --- the Assault on Medical Ethics in America. Smith, an attorney for the International Anti-Euthanasia Task Force and author of the 1997 book, Forced...




Author: Merrill A. Cohen, MD
Article Type: Feature Article
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


The four principles that guide current bioethical decision-making are beneficence, non-maleficence, autonomy, and distributive justice. Of these, the first three have been thoroughly discussed in the medical and ethical literature over the past two decades. The many issues that relate to these first three principles, such as consent, abortion, termination of treatment and end-of-life decisions, euthanasia, in-vitro fertilization and cloning, etc., likewise have been well scrutinized. The principle of distributive justice is currently the subject of discussion in the medical literature, and it increasingly is being incorporated into physician thinking. Is distributive justice a principle physicians should adopt? This essay explores the meaning and use of the bioethical principle of...




Author: Jerome C. Arnett, Jr., MD, FCCP
Article Type: Editorial
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Changes in health care delivery threaten the values of professionalism and are tempting physicians to reject their commitment to the "primacy of patient welfare." So claims a new group, the Medical Professionalism Project, which is comprised of delegates from three medical organizations --- the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) Foundation, the American Board of Internal Medicine (ABIM) Foundation, and the European Federation of Internal Medicine. After several years of work they have developed a new code of ethics, the so-called Charter on Medical Professionalism, which they claim is necessary in order to "maintain the fidelity of medicine's social contract" and to encourage "collective efforts to improve the healthcare system for the welfare...




Author: Jerome C. Arnett, Jr., MD, FCCP
Article Type: Commentary
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


The foundation of any culture is its philosophy. Over the past few years, a new culture has appeared in America, which has been associated with increased suffering and death. Characterized as a "Culture of Death," its underlying philosophy is a subjective one and its ethics is a result of the 30-year-old faith-based social movement known as, bioethics.(1) Instead of enhancing our happiness and prolonging our lives, the expected outcome of a proper code of ethics, bioethics has led to increased suffering and death by way of several gimmicks including the "quality of life ethic," "futile care theory," the "duty-to-die" ethic, death by dehydration, assisted suicide, and euthanasia. Bioethics has been promoted by a cadre of gurus that has been labeled the "Priesthood of Death." These gurus...




Author: Compiled by Medical Sentinel Editors
Article Type: News Capsules
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


MSAs: A Real Patients' Bill of Rights "The Senate and House have passed different versions of the so-called Patients' Bill of Rights which have yet to be resolved, but both versions involve more federal funding and more federal regulations. A real Patients' Bill of Rights would give us more choice and more competition, and would allow individuals to own our health insurance just as we own our automobile insurance. "Only the House bill (H.R. 2563) contains a provision, which offers that kind of hope to reform our health care system. The Medical Savings Account (MSA) provision in the House bill (passed Aug. 2, 2001 by 236 to 194) is the approach that can simultaneously address the problems of high costs, increasing numbers of uninsured, and prescription drugs. MSAs will also solve the...


MSA


Author: Robert R. Urban, MD
Article Type: President's Page
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


It has been said that there is no such thing as coincidence --- that all happenings have their reasons. Several days ago, I was conversing with physician friends about the reasons for the current medical and professional dilemma, physicians and patients finding themselves hopelessly overwhelmed by the government and the insurance industry. On the following day, while purging files in my den, I came across an article on this very subject, which I had written in 1995. The article went like this: "As the Fall issue of The Seppian is about to go to press, I feel compelled to speak out on a deep concern and a pet peeve of mine. The French have a word for it --- insouciance --- light-hearted unconcern. Some other synonyms are apathy, disinterest, indifference, disregard, heedlessness,...


HMO


Author: Miguel A. Faria, Jr., MD
Article Type: Editor's Corner
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


March 20, 2002 Dear Mr. Smith, You have done a great service to the public as well as to the medical profession with your groundbreaking books, Forced Exit: The Slippery Slope From Assisted Suicide to Legalized Murder (1997) and Culture of Death: The Assault on Medical Ethics in America (2000).(1,2) You have brought to the forefront of popular discussion momentous medical issues, which up to now have been restricted to the ivory towers of academia or to acts conducted in the shadows by the likes of Dr. Jack Kevorkian. You will be happy to learn that there is one medical organization that does not compromise principles for political expediency or social considerations. While other medical organizations have allowed the individual-based medical ethics of Hippocrates to be eroded piecemeal,...




Author: Curtis W. Caine, MD
Article Type: The Constitution - Plain and Simple
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


In a business or organization an industrious person with ability and ambition may, by hard work and ingenuity, rightfully gain a position of authority over others who voluntarily submit. But in this world, throughout history, there have been and are those who have an insatiable, inordinate desire to have Power over and control of others, without their permission. Such a person may resort to direct, one-on-one violence to gain his goal. Of course, in this situation there is the risk that the intended victim may be the victor! Or, the aggressor may increase his odds by forming a gang to satisfy his lust. Tyrants throughout history have resorted to this tactic. However, in many areas of the globe laws forbidding plunder stand in the way. In the(se) United States, our Republic was forged...




Author: Conrad F. Meier
Article Type: Report from the States
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


A proposal to implement single-payer health care in Maryland could cost the state as many as 117,000 jobs and as much as $4.89 billion in lost payroll tax receipts, according to a study jointly released last November by The Heritage Foundation and the Maryland Foundation for Research and Economic Education (Maryland FREE). The report, prepared by analysts at the Boston-based Beacon Hill Institute (BHI), considers the economic implications of four universal health care proposals legislators are expected to consider during the 2002 General Assembly session. "Universal Health Care and the Maryland Economy" relies on the State Tax Analysis Modeling Project (STAMP) computer model developed specifically for Maryland. STAMP measures the effects of public policy changes by applying statistical...




Author: Twila Brase, RN
Article Type: Report from the States
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Outrage over the latest proposed modification to the federal medical privacy rule is misdirected and political. Had this kind of outrage been expressed by the media and non-profit organizations a year ago, there would have been more opportunity to protect patient privacy the way the public wants their privacy protected. Reporters are understandably upset over the proposed elimination of patient consent by the Bush administration. But what also needs to be changed --- what isn't being discussed and should have been debated a year ago --- is the provision that gives federal officials and numerous others full access to the medical records of every American --- without patient consent. The patient consent provision the Bush administration proposes to delete relates only to use of data for...




Author: Reviewed by Jerome C. Arnett, Jr., MD
Article Type: Book Review
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Thirty-six years ago after a harrowing ordeal at sea, Miguel A. Faria, Jr., escaped from Cuba with his father and found a new home in the United States. Cuba's loss was America's gain. A consummate historian, Dr. Faria here applies himself with gusto, using a treasure-trove of inside information to tell his personal odyssey and to reveal the true story of the Cuban Revolution and its sell-out to communism. Especially noteworthy are the unknown stories of the Cuban patriots who fought Castro's communist regime. In Cuba in Revolution --- Escape From a Lost Paradise, Faria exposes the culpability of the U.S. State Department not only in support of the revolution but also later in the Bay of Pigs disaster and reveals the fawning over Castro by America's liberal elite on his 1995 and 2000...




Author: Reviewed by Del Meyer, MD
Article Type: Book Review
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Bioterrorism took front and center stage in October 2001, only a month after the terrorist attacks on the World Trade Center and the Pentagon. But, the United States has been threatened by terrorism for more than 15 years, e.g., the 1984 Salmonella contamination in Oregon and the 1996 Shigella hospital contamination in Texas. In 1998, Robin Cook, M.D., points out in Vector (Penguin Putnam, Inc, ©1999) that what his characters say about bioweapons and bioterrorism is true. Cook states that it is not whether a major bioterrorism attack in the United States will occur, but when. As he predicted, anthrax spores were sent by mail three years later, in October 2001. With a few dozen envelopes, terrorists have demonstrated that almost anyone can be affected. As a result, three people have died...




Author: Robert P. Gervais, MD and Jerome C. Arnett, Jr., MD
Article Type: Correspondence
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Dear Dr. Arnett, ...The author of “Is there a Duty to Die” [philosophy professor John Hardwig, East Tennessee State University] utilized the same misguided arguments to “justify” death as those proposed centuries ago to defend the indefensible, namely, slavery. Misguided philosophies redefine terms in order to justify the attainment of predetermined ends. That is to say, in order to justify the extermination of the sick human, the latter is conveniently redefined as a non-person. Likewise, in order to justify “people stealing” or slavery, misguided philosophies of yesteryear redefined black humans as less than persons or subhuman. The redefinition of terms to suit the moment undergirds totalitarian or leftist ideology. For example, most laws passed by all current governments are...




Author: John M. Sherman, MD
Article Type: Correspondence
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Dear Editor,...In the early 1990s as mangled care and the government began in earnest to take over medicine, I decided I’d had enough. I’ve always believed that ethical medical care cannot be delivered by a physician who has subordinated his judgment to that of an entity, such as the government or an insurance company, which has a vested interest in limiting or controlling health care. I felt, also, that it was the primary physicians who had the major part of the battle on their hands, as it was they and not the specialists, who were the entry points to the health care system. Since I had thirty years of practice in a large southwestern city, a practice with no Medicaid and thirty percent Medicare, I decided if there was one primary physician in our area who could opt out of Medicare, it...




Author: Mary Jo Curran, MD
Article Type: Correspondence
Issue: Summer 2002
Volume Number: 7
Issue Number: 2


Dear Editor,It has been three and one-half years since I opted out of Medicare and I couldn’t be more satisfied. Before I took the step, I was always resentful my fees were fixed by the government and were so low that I could not cover my overhead. Then I had to constantly contemplate the disturbing thought that if I made an inadvertent coding error, I could be fined and prosecuted. Philosophically, I also considered the Medicare program to be anti-American and anti-freedom. I resent the unjust manner in which Medicare is administered by the bureaucrats and the so-called fraud and abuse witch hunts that threaten the livelihood of every physician. Medicare is the antithesis of the values that were the foundation of this country and a constant peril to our constitutional liberties. Any MBA...



It is now legend the AAPS legally lanced the secret task force and pulled its secrets...into the sunshine. It destoyed the Health Security Act.


The Oath of Hippocrates
and the Transformation of Medical Ethics Through Time


Patients within a managed care system have the illusion there exists a doctor-patient relationship...But in reality, it is the managers who decide how medical care will be given.


Judicial activism...the capricious rule of man rather than the just rule of law.


The largest single problem facing American medicine today is the actions of government...


The lessons of history sagaciously reveal wherever governments have sought to control medical care and medical practice...the results have been as perverse as they have been disastrous.


Children are the centerpiece of the family, the treasure (and renewal) of countless civilizations, but they should not be used flagrantly to advance political agendas...


Prejudice against gun ownership by ordinary citizens is pervasive in the public health community, even when they profess objectivity and integrity in their scientific research.


The infusion of tax free money into the MSA of the working poor give this population tax equity with wealthier persons...


It was when Congress started dabbling in constitutionally forbidden activities that deficit spending produced a national debt!


Does the AMA have a secret pact with HCFA?


The lure of socialism is that it tells the people there is nothing they cannot have and that all social evils will be redressed by the state.


Canada's fatal error — Health Care as a Right!


The Cancer Risk from Low Level Radiation: A Review of Recent Evidence...


...Moreover, the gun control researchers failed to consider and underestimated the protective benefits of firearms.


Vandals at the Gates of Medicine — Have They Been Repulsed or Are They Over the Top?