CH. 5

Ethics are the issues that stand out for me in Ch. 5 of "The Social Transformation of American Medicine."

One of the most interesting things here is how Starr takes a strong stance as an aside to refute accusations or interpretations of the motivations of the medical community made by Marxists and Liberals. While Starr has generally maintained a style of "objective writing," his footnotes and later sections of the book are unabashedly pointed. But it is his statement...

"Insofar as public health and medicine reduce disease, they augment the power of individuals to realize their own objectives, not simply to fulfill socially prescribed obligations."

...that makes me consider the two kinds of ethics described in one of the course tutorials. Medical ethics are defined as promoting individual autonomy while public health ethics have a caveat stating that individual autonomy should be respected unless it conflicts with the social good or causes another or others harm. While certainly neither is a set-in-stone definition, it is interesting to consider how Starr defends public health ethics as providing a source of self-actualization and autonomy, when part of the reality of public health is defining what individuals should and shouldn't do as rationalized by its impacts on the welfare of society. Clearly this is an oversimplification, but it was something that piqued my interest as I encountered it.

To continue with ethics, while describing the formation of health clinics, the irony could be cut with a knife when I read about medical professionals balking and ultimately shutting down a low-cost health clinic on the grounds that it unethically competed with their services. the choice to label these reasons as a matter of ethics is ironic, given the harm that it did to patients who were poor and could not afford the almost 500% greater fees charged by medical professionals. Part of the Hippocratic Oath is the promise to "do no harm." Yet this action is an indirect violation of this promise.

The issue arises again in recounting the restrictions imposed on county health departments by officials due to the pressure from the medical professional community. That there would be restrictions from performing "any curative medicine" is absurd, as stated in the text, and highly unethical in my opinion. I begin to wonder when ethics became the primary concern and not the status and power that medical professionals continued to demand ("...Too little recognition and power is [sic] given to the medical professional..." [for a flashback, the quote at the end of page 164 in Ch. 4 is another great example of this, and would be a hoot and a holler if it wasn't so depraved.])