Monday, October 26, 2009

The Morality of Medicine: The Traditional View of Hippocrates, and a Newer View From Arthur C. Brooks

Arthur C. Brooks, the president of the American Enterprise Institute in Washington DC, takes to the editorial page of The Wall Street Journal this morning to set forth his vision for healthcare, in a piece headlined, "Why Government Health Care Keeps Falling in the Polls/The health-care debate is part of a larger moral struggle over the free-enterprise system."

After appropriately chopping up Obamacare, Brooks closes his piece with this peroration:

The health-care debate is part of a moral struggle currently being played out over the free enterprise system. It will be replayed in every major policy debate in the coming months, from financial regulatory reform to a cap-and-trade system for limiting carbon emissions. The choices will ultimately always come down to competing visions of America's future. Will we strengthen freedom, individual opportunity and enterprise? Or will we expand the role of the state and its power?

Brooks is thus saying that healthcare should be seen as a piece of the larger "moral struggle" over the free market, and economic freedom. Or to put it another way, he is saying that the the first principle should be freedom and free enterprise, and that other considerations, including medicine, should find their place within that principle. Principle first, to be followed by the application of that principle to other areas, including healthcare.

But actually, personal freedom doesn't come first in all areas. For example, I doubt that Brooks intends for "freedom, individual opportunity and enterprise" to prevail in the area of drugs, abortion, and the extremes of entertainment and scientific experimentation. Why? Because in some areas, morality trumps the market. We don't want a free market in child exploitation, for example.

Most libertarians/free marketeers/objectivists allow for the role of morality in some sectors of society--and they understand that the law enforcement needed to enforce the dictates of our collective conscience is also not to be left to the free market.

So the more precise question is whether or not healthcare should be part of this non-market "moral sector," or, instead, part of the market sector. And on that question, Brooks lays down his cards in favor of market pre-eminence. As he writes this morning, "The health-care debate is part of a moral struggle currently being played out over the free enterprise system."

But there is a different view, deriving from our roles as moral and charitable and spiritual beings, existing within some sort of universal order. Across the eons, across cultures, people have felt inspired to do good works, out of charity, compassion, love, and faith. This view is thus larger than the market, since it includes everything that human beings do--or should do, if they wish to do their best. Applied to medicine, these impulses were perhaps best distilled, 2500 years ago, by Hippocrates. His famous Hippocratic Oath is reproduced below. Note that it begins with an oath to the gods, not to any earthly institution:

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

There's plenty here for people to disagree with, and plenty that some might wish to see changed. (And did I mention that Hippocrates was pro-life?)

But what's clear, here, is that the Hippocratic Oath is an oath to the divine, not to the free market: As the Greeks put it: "I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea." Of course, doctors today swear an oath only to the memory of the Greeks and to the rational and ethical traditions they fostered. Doctors today are more likely to feel a duty to God--that's a medieval rendition of the Hippocratic Oath, pictured above, written out in the shape of the cross--or else a duty to some other ideal, such as service of humanity, or to the pursuit of scientific knowledge. But all those goals are notable for having one thing in common: In their idealism, they transcend the free market.

And yes of course, some doctors will absolutely swear an oath to fortune, or to fame, or to their own ego. But I believe that such materialistic doctors are in the minority. Doctors might not be saints, but most of them have altruistic motives.

So should the free enterprise system have a place in health and medicine? Absolutely. Here at Serious Medicine Strategy, we have always argued that we need the full panoply of resources to the cause of better health and cures. We want incentives, the profit motive, and yes, greed, all harnessed to the cause of creating new treatments and improving well-being. That's all a part of an overall Serious Medicine Strategy.

But the free market is just one strand within this larger Strategy, other strands include compassion, idealism, pragmatism, national objectives, and international cooperation. And yes, the desire to do God's work here on this earth. Together, we can create a national effort that will enlist the talents and energies of everyone who wants to improve life--that's a much larger percentage of the population than just those who wish to celebrate the free market. And in politics, bigger numbers of people have a way of trumping smaller numbers.

The Serious Medicine Strategy has a place for the free market, but does not seek to maximize the free market. The SMS seeks to maximize the prospect of improving the health and well-being of the American people, and of all the people of the world. And to my reckoning, such an achievement would be a moral and ethical achievement of the highest order.


  1. The healthcare debate is a struggle amongst politicians who aren't listening to "We the People." We who don't want them messing with the best health care system in the world. Their motives are suspect. If you don't believe me, ask Hippocrates. Oh, I forgot, there are people who disagree with him and Moses and anybody else who gets in their selfish, corrupt and egotistical ways. We call these people "Politicians." Thank God there is a November! It will be the new spring cleaning month. Ok people can I hear a big AMEN on those last two sentences? :-)

  2. In a true system of INDIVIDUAL freedom and free enterprise, we would not be subject to the "tax exploitation" that we are now and would be able to decide how the fruits of our labors are prioritized and spent. If our employers paid us every dime we earned, we could pay our necessities first (food, housing, health care, the means to make a living) and taxes second, limiting how much the government could spend. By abdicating so much of our individual liberty to our government, and in some cases our employers, we have abandoned much of our personal responsibility and have allowed ourselves to become dependent and corrupted in such a way that we now seek to justify yet more taking for the "common good" in terms of morality. Compassion and charity do not begin at the end of a gun, fine or jail sentence.