Academic journal article Issues in Law & Medicine

How Can We Best Care for Persons Who Are Medically Indigent in a World of Limited Resources?

Academic journal article Issues in Law & Medicine

How Can We Best Care for Persons Who Are Medically Indigent in a World of Limited Resources?

Article excerpt

The doctor was closing his bag now. He said, "When do you think

you can pay this bill?" He said it even kindly. "When I have sold my

pearl I will pay you," Kino said. "You have a pearl? A good pearl?"

the doctor asked with interest.

The framing of the question determines the architecture of its answer. Perhaps this is why medical ethicists derive extensive verbal mileage from the dictum "We must first learn to ask the right questions." Even then, we can be too hasty. We must first recognize the "wrongness" of the old questions. We must learn to disassemble "rotten" presuppositions to prevent the revamping of old questions behind facades of newly constructed terminologies.

The title for this medical students' and residents' ethics essay contest, "How Can We Best Care for Persons Who Are Medically Indigent in a World of Limited Resources?" provides the structure from which the author will begin to build new answers. First, the "wrongness" of the title question will be critically analyzed. Second, a new question, possibly a "right" one, will be suggested. Finally, some creative answers will be discussed.

The "Wrongness" of the Question

The question "How can we best care for persons who are medically indigent in a world of limited resources?" has four presuppositions as its cornerstones: (1) We (American physicians) are expected to intervene; (2) a "best" care approach exists for persons who are medically indigent; (3) persons who are medically indigent would be better off if we did intervene; and (4) limited resources in this world are a primary contributing factor to medical indigence. These premises are faulty and disable us from raising new questions, if not "right" ones.

American Physicians Are Expected to Intervene

"There is no place in the world," not even third-world countries, "where people are more dependent on doctors and medicines and hospitals for their health" than in the United States.(1) Meanwhile, "seven of the ten leading causes of death in the U.S. are related to a person's lifestyle."(2) The "pearl" of health is valued without the discipline required to produce it. In essence, Americans want to feel better without having to act better. "As control over the behavior of a person has shifted from family and church to physician, |be good' has shifted to |take your medication.'"(3) Idolatry of wellness has become religion with hospitals and clinics as its mecca and pharmaceuticals as its sacraments. Physicians, now called "health providers," are expected to make patients responsible for what patients have not been responsible for themselves (e.g., stopping smoking, decreasing cholesterol, having safer sex, losing weight, learning to relax, decreasing alcohol intake, and increasing exercise). Of course, this insurmountable task must be done without making anyone feel guilty--i.e., "Doctors should not play God!" They should just be valueless priests who listen to confessions and absolve sins with a wave of prescriptions.

With media-sized expectations, Americans congregate to their physicians and to their government leaders, not only desiring to be made healthy, but demanding health as a guaranteed "right." Americans have erroneously equated the concept of health with the practice of medicine.

Medicine is a short-term intervention, or a monitored nonintervention, to ward off acute illness and impending death. Medicine is not a guide for health any more than criminal law is a guide for virtuous behavior. Both professions are designed to remedy intolerable aberrations, social ones for law and individual physical and mental ones for medicine. Neither has much to say to those living "well" for the moment; neither points toward optimal or virtuous behaviors. We usually don't encounter the medical or justice systems unless something is "wrong."

Health, as opposed to medicine, is a condition of living belonging to an individual and related to culture-bound values. …

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