Tuesday, September 16, 2008

Catholic Medical Ethics and Medical Student Idealism

As I wrote in a post last September, except for the area of reproductive ethics, I'm a big fan of Catholic Medical Ethics, especially the strong commitment to social justice and the deeply held view of medicine as a calling. So when I saw that the National Catholic Register had an article called "Health Care, U.S. Style: What's Wrong with Our System...and How We Got It" I went to the website.

I wasn't disappointed. The article exudes moral passion.

What struck me most was the last three paragraphs:
“The key to the crisis in American health care today is that it violates essential norms of justice and charity on both sides of the physician-patient relationship,” the Catholic Medical Association’s 2004 health-care document states. “It impairs the ability of the physician to decide and act as Jesus would, and it ignores the dignity of the poor in countless ways.”

...Retired surgeon Passinault agrees that serious problems exist. Yet, he remains hopeful, citing the selfless attitudes that predominate among the second-year medical students who take his medical ethics course at the Grand Rapids branch of Michigan State University’s College of Human Medicine.

“I’m actually quite impressed with the humanitarian perspective of young medical students,” Passinault said. “I really do think the majority of students enter their profession with those kinds of attitudes — we just have to be good role models so they know they’re not alone.”
I agree with everything here (except that as a Jew I might substitute Moses Maimonides for Jesus). But I think the order is wrong. The first of the three paragraphs should come last.

Dr. Passinault, a retired surgeon who chairs the ethics committee at St. Mary's Hospital in Grand Rapids, and with whom I had an excellent conversation at an ethics meeting, is right about the idealism that most medical and other health professional students bring with them into the field. The failings of our health system are not caused by deficient idealism, but by structural factors that "violate essential norms of justice and charity [and, as a result] impair the ability of the physician to decide and act as [Jesus, Maimonides, Schweitzer, Mother Theresa, Jane Adams, and other moral leaders] would..."

We won't improve the health system by preaching to or scolding practitioners. We need to make the system within which they work support "essential norms of justice and charity." The biggest challenge is better stewardship of shared resources so that we can achieve full coverage, support safety net programs, and allow our idealistic students to graduate without huge debts. When we've achieved more justice and rationality in the system our students graduate into, preaching about ideals and scolding lapses will become more relevant.

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