Ethics And The Health Professions:

Relating The Memory Of The Shoah To The New Managed Care Millennium

Harold J. Bursztajn, M.D.

Knowledge from the history of medicine and ethics is relevant today when third-party administered resource constraint in the doctor-patient relationship is fast becoming the rule rather than the exception. Under these conditions, physicians need to learn how to recreate doctor-patient relationships which can continue to function with relative autonomy, and as an authentic healing relationship, even when facing role conflict and dual agency, and cost and time constraints administered by third parties.

Speaking freely with patients about role conflict, communicating a sense of ongoing responsibility, and settling disputes in non-adversarial settings were each characteristically practiced by physicians aiding in-ghetto Resistance during the Shoah. There are parallel health care policies which, if implemented, can encourage physicians wishing to apply ethical principles to the practice of medicine in administered health care settings. These include elimination of health care provider "gag" clauses and mandating ongoing ethical responsibility to patients by clinical "gatekeepers" subsequent to referral and third party providers subsequent to benefit review decisions. Encouraging readily available alternative dispute resolution pathways to the current adversarial system of adjudication of conflict is a third component toward creating an atmosphere where health care can be delivered efficiently and ethically.

We can also facilitate applying what we know about ethical principles to clinical practice by way of educating practitioners to meet the challenges of caring for patients in an increasingly complex health care delivery system. Integrating such knowledge in the core curriculum preparatory to the National and American Board of Medical Specialties examinations is one additional incentive for alliance building and authentic caring among relatively autonomous patients. All continuing medical education courses in all specialties can be also designed to have an ethics component as the rule, rather than the exception.