Health Care is a Privilege
What happens when the standard for ethical medicine is subjective?
Most people have heard of the Hippocratic Oath. For thousands of years, newly minted physicians have taken some version of the oath, which is widely regarded as the foundational text in western medical ethics. Supposedly, the oath was written by Hippocrates, a physician in ancient Greece, but modern scholars are skeptical of this claim. Today, many believe that the oath contains the famous phrase “first, do no harm.” Early manuscripts don’t contain this phrase, although the oath does emphasize that a core obligation of medical practitioners is to avoid interventions that will worsen or complicate the health condition of patients.
Another common misconception is that American candidates for the degree of medical doctor (M.D.) are all required to take the oath. In fact, the oath has frequently been modified, paraphrased, edited, or ignored entirely. Indeed, many of the ideals expressed in the oldest versions of the oath would seem downright barbaric in an advanced society like our own. For example, the oldest manuscript of the Hippocratic Oath requires new physicians to promise not to participate in abortion procedures. Needless to say, that prohibition was aborted long ago.
Nevertheless, it has historically been true that schools of medicine have established some consensus view of medical ethics, to which they have required their graduates to pledge allegiance. But as is true so often in our era, the old traditions have been demolished in favor of a radical subjectivism. An oath to which all must swear fealty is an intolerable injustice—only the sovereign individual can make decisions about how to ethically practice the medical arts.
Thus, Harvard medical school and others have allowed recent graduating classes to craft their own oaths. This is rather shocking. It seems to ignore the need for a consensus that would ensure that the medical community can punish malpractice and enforce compliance with a shared standard for care. When the individual physician is sovereign to determine which practices are right and wrong, which interventions are good and which are bad, how does the medical establishment maintain any authority to render judgments about these matters? This relativizing of medical ethics masquerades as a form of progress as it recognizes alternate ethical orientations are also purportedly valid. Allowing each doctor to decide right and wrong for themselves is sold as an affirmation of individual autonomy (the etymology of autonomy shows that the word literally means being “a law to oneself”). But injecting a subjectivist ethics into medicine comes at a high cost–specifically, it jettisons any universal ethical grounds that can guide medical practice.
The broadened scope of individual liberty in the practice of medicine will have negative consequences for patients. Not only will they lose a general understanding of their rights as a patient and what level of care to expect, their own individual liberties will be constrained. Increasingly, doctors unilaterally impose a particular form of treatment for a given condition or withhold treatment for arbitrary reasons. For example, consider that conservative commentator (and person of color) Candace Owens was recently denied access to a Covid-19 test on the grounds that she has been “making things worse” by questioning official pandemic policies. There have been a number of reports that doctors are feeling “compassion fatigue” for unvaccinated Covid patients, and many physicians have determined they will deny treatment for the unvaccinated or will deprioritize them when time or resources are limited. When the vaccine became available, many in the medical community argued that early access to the vaccine should be given to racial and ethnic minorities who are allegedly “disproportionately affected” by the virus. The Biden administration (which promised vaccine mandates would not be implemented) unconstitutionally demanded private businesses with over 100 employees to require the vaccine—an overreach which the Supreme Court thankfully nixed.
So, let’s recap the whimsical biases that have motivated these examples of medical decision-making: You can deny care to someone who has been critical of public policy; you can deny or deprioritize care on the basis of a patient’s decision to forego a particular medical procedure or intervention (i.e., the vaccine); you can allocate medical care based on the race of the patient in need; and the federal government is willing to coerce private entities to require employees to undergo a medical procedure as a condition of their employment. What we are seeing, then, is a new concentration of power in the medical community. This power is multifaceted. Not only are doctors consolidating more power in terms of what interventions they will (or will not) provide, they now have more power to make those determinations on the basis of their own personal, non-medical opinions.
Perhaps more important, though, is the collusion between state power and medico-scientific power. Scientists and scientific data have long played an important advisory role in the application of governmental power. The pandemic has pushed us a step further. It is now evident that the medical establishment doesn’t merely advise the state. Rather, it has taken on some power of the state itself. Establishment “science” now largely dictates public health policy, with the government playing the role of the junior partner who simply ensures compliance and obeisance to medical experts who have no legitimate political authority. Experts and scientific research that challenge the official narrative is repressed and attacked.
The same people who insist that health care is a human right are now providing care only at their discretion. Didn’t get the vaccine? You aren’t a priority. Expertise becomes entitlement: Being an “ethical” physician now means prioritizing the needs of certain patients based on arbitrary characteristics of their personhood (race, class, gender) or on the palatability of the patient’s politics in the eyes of the attending physician.
Arguably, this is a byproduct of the collapse of cultural Christianity. Part of the attractiveness of Christianity in the ancient world was early Christians’ willingness to provide care to people that the elites designated as untouchable: people with the plague, slaves and serfs, foreigners. While Hippocrates represents an obvious Greek influence in western medical ethics, Christian ethics left an indelible impression upon modern western medicine. The right of physicians to deny care to particular individuals at their discretion (endorsed by the same people who insist the state must provide “free” medical care “for all”) is a result of the decline of Christianity and its universal ethic of mercy owed to all human beings, regardless of identity or politics. This change also represents a new classism, expressed through a subtle form of coercion: “if you untrained pedestrians want me to use my expertise to relieve your pain and suffering, you better adapt your worldview and behavior to my personal preferences. Otherwise: heal thyself!”
And it must be noted that this new outlook is justified as a higher ethic. The old medical ethic asked practitioners to consider their ethical obligations to others, non-experts, in medical need. The new ethic asks practitioners to consider their ethical obligation to themselves. They must remain “true to themselves,” and that means exercising a prerogative not to care for those they deem to be “problematic” or less-deserving of health for one reason or another.
Would these woke doctors refuse to treat a man or woman who illegally crossed the border into America and needed treatment for small pox, having never received a vaccination? How about to a monied Bay-Area progressive mother who refused to vaccinate her children or herself against measles and then got sick? Unlikely. What is the ethical justification for prioritizing non-citizens over citizens, or urban progressives over rural conservatives? There is no logic here: only the arbitrary whims of individual health care providers.
Although the left continues to chant their mantra of “Health Care is a Civil Right,” it is clear that medical treatment is being turned into a privilege: a gesture of elite benevolence that may be withheld if the patient is deemed to be non-compliant with the fiats of the medical community. These fiats may be dictated by state authorities, but only after the unelected scientists of the bureaucracy whisper them in their ears. There is some delicious irony here. The people who have turned health care into a privilege—the ones who exercise personal discretion over who will be treated and how—are the same ones who deny treatment to everyday Americans on the basis of their supposed “privilege.” Through these contradictions, various classes of citizens are dehumanized, a reality reflected in Biden’s hissing petulance when he scolded the unvaccinated and warned them of a “winter of death.” This sort of sentiment, whether voiced by a president or a scientist, expresses a disdain for the individual liberties exercised by a free people. And a people who value their freedoms can only repay these aspiring totalitarians with defiance.
Adam Ellwanger is a professor of English at the University of Houston-Downtown. He is the author of Metanoia: Rhetoric, Authenticity, and the Transformation of the Self, available in paperback this April. You can follow him on Twitter @DoctorEllwanger.