When I was in training, we used to hear horror stories about the coming “cook-book” medicine in which doctors would be given a list of preordained methods for diagnosing and treating various diseases handed down by medical elites. This relegates the physician to little more than a cog in the wheel of the State, obediently following orders handed down from the bureaucrats above.
Until quite recently, the practice of medicine was considered an art, which incorporated a significant modicum of science, yet was itself not a pure and applied science, such as physics, astronomy, biology, and chemistry. Sir William Osler (1849-1919), one of the greatest medical minds, not only in the science of medicine, but more so the art of medicine, has written:
If you asked most physicians in the past what one thing characterized their profession, the most likely answer would have been fierce independence. Unfortunately, this is no longer the case. We have been and continue to be battered from an all-out assault of collectivist forces that infest our society and the legal profession that drains our substance. As a result of this assault, we have become daunted — lot, leaderless, frightened, and overwhelmed with a sense of helplessness and doom in the face of sundry forces working tirelessly to affect our demise.
The crisis of American medicine is not tobacco, AIDS, silicone implants, the Gulf War Syndrome, breast or other forms of cancer, physician-assisted suicide, euthanasia, licensure, medical care for the poor, or any other specific medical or ethical issue. The crisis of American medicine is far greater than any one of these problems, indeed it is far greater than all of them combined, because the answers to these problems do not come from within them but from medical ethics.
In this essay, I propose to 'tour' the subject of privacy in our civilization, its importance and its pending destruction: Why does privacy matter? What should we expect from its destruction? Finally, does privacy in medical matters have a special significance? I will draw the conclusions that privacy is an extension of property rights; that respect for privacy, a bourgeois concept, is inherent in the success of our civilization and necessary for a thriving middle class. A thriving middle class represents the essence of Western civilization.
With warm regards to Dr. Pat Flanagan, and his insightful commentary on my article "You Copy That?" (Medical Sentinel, November/December 1999), I might contribute these few thoughts.
In Dr. Flanagan's commentary, he slightly misconstrues my stance on property rights and their application to clones.
Despite the assurances by managed care proponents that health maintenance organizations (HMOs) and other forms of managed care would solve the duel problem of spiraling health care costs and the rising number of the uninsured, that has not been the case. Public-private partnerships and managed care health initiatives which have been promoting the herding of workers and Medicaid and Medicare patients into HMOs have likewise failed to alleviate those problems, at least for the long haul.
Over the next three to four years, during President George W. Bush's second term in office, we can expect the United States Congress to continue to move in the direction of improving access and quality of medical care via the implementation of affordable, free market solutions, particularly Health Savings Accounts (HSAs).