Ethics, medicine, economics and power

Page 37 

Today’s doctors face a bewildering array of choices and constraints, from technological discovery to increasing budget pressures. Their dilemmas go beyond diagnosis and treatment to weighing the benefits of new discoveries and whether society is willing to pay for them.

The health world has undergone a number of profound changes in recent years, from population ageing and the fact that people are increasingly well informed, to industrialisation of healthcare, squeezed budgets and the biotech revolution. These changes have raised serious questions for all those involved in healthcare. Is there a code of ethics regarding choices? And if so, how does it compare with the criteria on which the philosophy of medical practice has been built from antiquity to today?

In fact, it is the very purpose of the medical profession and the doctor’s role that is at stake today. Time and again doctors are forced to question the purpose of their actions and accept the limited extent of their knowledge in the face of the dizzying array of new discoveries in molecular biology and genomic sciences. At the same time they must weigh their sense of compassion and altruism as they help the sick who entrust their lives to them, against the pressure to use community resources responsibly.

Increasing legal complications and the media spotlight do not help either. All of this has been compounded by the gradual breakdown of traditional social structures, and the doctor’s diminished status in society.

In the midst of all these changes, what is a doctor, really? A learning machine supposed to know everything? An economic player whose sole job is to control the costs of treatment? A practitioner who must protect his livelihood from legal attack by practising a defensive form of medicine? Or is a doctor simply an illusory buffer against the suffering, anguish and solitude of his fellow human beings?

The answer would be easy if medicine were a science. But unfortunately (or perhaps fortunately), it is only an art. That is to say, a permanent quest for a philosophical absolute: Health, Well-being or perhaps even to some degree, Happiness.

And the problem does not stop with doctors. Hospitals are faced with an identity crisis of their own. How can they cope with the impossible task of providing an excellent, efficient service while remaining local, familiar and human?

We should not forget that it was to the hospitals that thousands of homeless turned at the height of the last economic crisis in the early 1990s, appearing in casualty departments in search of human contact or simply a bowl of food. They were not thinking about the high financial cost of appealing for help in this way. In 2000, 49% of the 80 billion euros spent on the French health system went on hospitals. A hospital like the one where I practice costs nearly FF 5 000 (760 euros) a minute to run, or almost a month’s minimum wage.

And families turn more and more to hospitals to look after their loved ones at the end of their lives, so that they can be as free as possible from suffering. But this means dying as far away as possible from the places where people have spent their lives – more than 80% of people nowadays die in hospital.

But these crises and contradictions are only on the surface, for it is in the outstretched hand, in the bowl of soup and in the silent support for the terminally ill that the essential meaning of the practice of medicine really lies. Just being there and showing compassion as life slips away is still a form of medical treatment.

Science alone cannot provide a definition of medical practice. It is just a tool. Indeed, the whole purpose of medicine would probably be lost, if in considering the illness the doctor were to forget the patient, or if in considering the pain he were to forget the suffering, or the hope. Another issue that is going to crop up increasingly in the future is the question of power.

Medical power was at its apogee after the Second World War, as symbolised in the relationship between an upright, healthy, clean and well-dressed doctor and an innocent, uneducated and silent patient confined to bed.

The doctor was all-powerful in his hospital world, at once terrifying and unintelligible. This status was underpinned by an absence of laws on ethics or respect for people subjected to biomedical research. There were no patients’ associations capable of standing up for the legitimate and inalienable rights of individuals entering hospital or putting their lives in the hands of a doctor.

Fortunately, the vast majority of doctors used their power wisely, with the sole object of helping their patients. However, we have seen the perverse effects that unbridled, inappropriate and inadequate use of such power and authority can have.

So where does the era of the Internet, lobbies and the media leave us? Doctors are seen by many as primarily those responsible for running up social security deficits and higher social charges, and as a heartless and incompetent lot.

This grotesquely inaccurate picture of the medical profession may conceal an underlying desire to destroy the origins of medical power at source. But it offers no concrete proposals for establishing a system capable of promoting health, eradicating suffering and respecting the life, value and dignity of all human beings.

France spends 10% of its GDP on health, but are the French satisfied with their health system? It is questionable whether they agree with spending so much on what seems to them to be a fairly remote asset, especially if they are of an age that does not actually need its services.

Nor can it be said that the French health system itself is happy with the resources it has, when 50 000 of its 800 000 staff end their careers early, and 3 000 of the 39 000 jobs for hospital doctors remain vacant. Can we say that we have answered the legitimate hopes of young people in terms of equity and compassion when we tacitly accept that people with AIDS or cancer in Europe will be cured whereas if they were African or Asian, poor and submissive, they would be left to die uncared for?

Answers will have to be found to such questions. Otherwise our health systems risk collapsing under the cumulative burden of budget squeezes, a crisis of conscience among doctors and the emergence of a patients’ lobby that is filling the void left by medical power.

Yet despite the difficulties of a world in the throes of far-reaching change, there is no reason to be pessimistic. Other values are helping us find answers to the pressing challenges facing a system that no longer knows which way to go. For in reality, power and purpose can only make sense through sharing.

Sharing means the individual, unique and privileged relationship between doctor and patient, it means respect for others, the right for all to equal access to quality care, the right to share knowledge, the patient’s right to dignity and hope.

Through sharing patients and doctors, administrators and economists, businesspeople and researchers can forge an unbreakable alliance and at last create the conditions needed for a health system that lives up to everyone’s hopes and makes proper use of scientific achievements and potential. As a result, all can be sure that every effort will be made, within the limits of available resources, to ensure that human beings live fulfilling, happy and healthy lives.

Each country and each region will of course have to define its own health priorities by democratic means, taking account both of requirements and resources.

In the same way, it is vital that overall “governance” of these issues involves sharing between North and South. Lastly, encouragement must be given to schemes to back the right of young people to become involved in health-related charities.

Economics, whether national or global, cannot be a substitute for ethics. Economics imposes choices and ethics helps us to make them.

We need a renewed code of ethics, based on choice, shared power and an efficient health system open to all. Everyone can then assume his or her share of that power with one principle in mind: that everybody in the world should have the same rights and the same opportunities in the face of sickness, suffering and adversity.

©OECD Observer No 229, November 2001 




Economic data

E-Newsletter

Stay up-to-date with the latest news from the OECD by signing up for our e-newsletter :

Twitter feed

Suscribe now

<b>Subscribe now!</b>

To receive your exclusive paper editions delivered to you directly


Online edition
Previous editions

Don't miss

  • Africa's cities at the forefront of progress: Africa is urbanising at a historically rapid pace coupled with an unprecedented demographic boom. By 2050, about 56% of Africans are expected to live in cities. This poses major policy challenges, but make no mistake: Africa’s cities and towns are engines of progress that, if harnessed correctly, can fuel the entire continent’s sustainable development.
  • “Nizip” refugee camp visit
    July 2016: OECD Secretary-General Angel Gurría visits the “Nizip” refugee camp, situated between Gaziantep and the Turkish-Syrian border, accompanied by Turkey’s Deputy Prime Minister Mehmet Şimşek. The camp accommodates a small number of the 2.75 million Syrians currently registered in Turkey, mostly outside the camps. In his tour of the camp, Mr Gurría visits a school, speaks with refugees and gives a short interview.
  • OECD Observer i-Sheet Series: OECD Observer i-Sheets are smart contents pages on major issues and events. Use them to find current or recent articles, video, books and working papers. To browse on paper and read on line, or simply download.
  • Queen Maxima of the Netherlands gives a speech next to Mexico's President Enrique Pena Nieto (not pictured) during the International Forum of Financial Inclusion at the National Palace in Mexico City, Mexico June 21, 2016.
  • How sustainable is the ocean as a source of economic development? The Ocean Economy in 2030 examines the risks and uncertainties surrounding the future development of ocean industries, the innovations required in science and technology to support their progress, their potential contribution to green growth and some of the implications for ocean management.
  • OECD Environment Director Simon Upton presented a talk at Imperial College London on 21 April 2016. With the world awash in surplus oil and prices languishing around US$40 per barrel, how can governments step up efforts to transform the world’s energy systems in line with the Paris Agreement?
  • Happy 10th birthday to Twitter. This 2008 OECD Observer interview with Henry Copeland said you’d do well.
  • The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. The gender portal monitors the progress made by governments to promote gender equality in both OECD and non-OECD countries and provides good practices based on analytical tools and reliable data.
  • Once migrants reach Europe, countries face integration challenge: OECD's Thomas Liebig speaks to NPR's Audie Cornish.

  • Message from the International Space Station to COP21

  • The carbon clock is ticking: OECD’s Gurría on CNBC

  • If we want to reach zero net emissions by the end of the century, we must align our policies for a low-carbon economy, put a price on carbon everywhere, spend less subsidising fossil fuels and invest more in clean energy. OECD at #COP21 – OECD statement for #COP21
  • They are green and local --It’s a new generation of entrepreneurs in Kenya with big dreams of sustainable energy and the drive to see their innovative technologies throughout Africa. blogs.worldbank.org
  • Pole to Paris Project
  • In order to face global warming, Asia needs at least $40 billion per year, derived from both the public and private sector. Read how to bridge the climate financing gap on the Asian Bank of Development's website.
  • How can cities fight climate change?
    Discover projects in Denmark, Canada, Australia, Japan and Mexico.
  • Climate: What's changed, what hasn't, what we can do about it.
    Lecture by OECD Secretary-General Angel Gurría, hosted by the London School of Economics and Aviva Investors in association with ClimateWise, London, UK, 3 July 2015.
  • Is technological progress slowing down? Is it speeding up? At the OECD, we believe the research from our Future of ‪Productivity‬ project helps to resolve this paradox.
  • Is inequality bad for growth? That redistribution boosts economies is not established by the evidence says FT economics editor Chris Giles. Read more on www.ft.com.
  • Interested in a career in Paris at the OECD? The OECD is a major international organisation, with a mission to build better policies for better lives. With our hub based in one of the world's global cities and offices across continents, find out more at www.oecd.org/careers .

Most Popular Articles

Poll

What issue are you most concerned about in 2016?

Unemployment
Euro crisis
International conflict
Global warming
Other

OECD Insights Blog

NOTE: All signed articles in the OECD Observer express the opinions of the authors
and do not necessarily represent the official views of OECD member countries.

All rights reserved. OECD 2016