Pushing Doctors into a "Dual Mandate" and the "Attack on Doctors’ Hippocratic Oath"

Physicians are being pushed steadily into an untenable position. On one hand, they are professionally obligated to render optimal care to each patient based on individual need. On the other hand, they are increasingly being looked to by bureaucrats and bioethicists as serving another role—for society—as the rationing arms of cost control.

The effect of this would require doctors to give optimal care to some patients but not others, probably based on mandatory invidiously discriminatory categories of age, disability, perhaps even politically incorrect lifestyles such as smoking and obesity (but never, for example culturally acceptable risky behaviors like promiscuity). This dual mandate, if adopted, would place doctors and other health care professionals in a terrible conflict of interest—duty to patient versus duty to society—carrying with it the real potential to tear health care apart.

The Hudson Institute’s Betsy McCaughey has noticed and raised the alarm in an important column in Investors Business Daily, entitled “Attack on Doctors’ Hippocratic Oath.” From the column:

Patients count on their doctor to do whatever is possible to treat their illness. That is the promise doctors make by taking the Hippocratic Oath. But President Obama’s advisers are looking to save money by interfering with that oath and controlling your doctor’s decisions.

Ezekiel Emanuel sees the Hippocratic Oath as one factor driving “overuse” of medical care. He is a policy adviser in the Office of Management and Budget (OMB) and a brother of Rahm Emanuel, the president’s chief of staff. Dr. Emanuel argues that “peer recognition goes to the most thorough and aggressive physicians.” He has lamented that doctors regard the “Hippocratic Oath’s admonition to ‘use my power to help the patient to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of the cost or effects on others.”

So yet another core patient protection in the Oath is under attack. This is nothing less than the deprofessionalizing of medicine, and turning physicians into health care technocrats.

McCaughey continues:

But President Barack Obama is pledging to rein in the nation’s health care spending. The framework for influencing your doctor’s decisions was included in the stimulus package, also known as the American Recovery and Reinvestment Act of 2009. The legislation sets a goal that every individual’s treatments will be recorded by computer, and your doctor will be guided by electronically delivered protocols on “appropriate” and “cost-effective” care.

Translation: Health care rationing; futile care impositions, assisted suicide—always cost effective; and a “duty to die” if your care becomes too expensive.

This is not alarmism:

Heading the new system is Dr. David Blumenthal, a Harvard Medical School professor, named national coordinator of health information technology. His writings show he favors limits on how much health care people can get. “... Now that Blumenthal is in charge, he sees problems ahead. “If electronic health records are to save money,” he writes, doctors will have to take “advantage of embedded clinical decision support” (a euphemism for computers instructing doctors what to do).

At which point medicine will cease to be a profession, as I mentioned above. And it will come at a great costs to individuals:

In critiquing the Hippocratic Oath, Dr. Emanuel calls for training medical students “to move toward more socially sustainable, cost-effective care.” He says the trend “from ‘do everything’ to palliative care shows that change in physician norms is possible.” What he fails to see is that government should not be interfering in decisions about when it’s time to say enough is enough to medical care.

McCaughey is spot on and her critique illustrates a truth I have only recently fully comprehended: The political Left isn’t about freedom, it is about power. And what greater power is there than bureaucrats and utilitarian bioethicists deciding whether you are treated or denied care, indeed, whether you live or die?

No wonder Obama wants his power grab, euphemistically called, “health care reform,” through the Congress without any meaningful debate.