What do I mean by moral duty?
Moral duty is the obligation to act based on ethical principles when we see other people’s well-being in danger. That would, of course, include our patient’s well-being. Assuming we accept this -- whose obligation is it to act? Is it the hospital? The doctors? The payors? Industry? The universities? Or is it someone else’s obligation? Who is the observing “we” in our definition?
This may be the crux of the problem. We have all collectively absolved our responsibility for the current state that has led to a Medical Care Crisis. The fact is the medical care environment has the responsibility of establishing its own standards. Its own moral duty. That means collectively the components of the medical care environment – doctors, hospitals, payors and universities/innovators – must come together and establish the ethical principles upon which everyone agrees support patient well-being. To do this, the medical care environment must have a forum, an organized gathering of leaders with the authority to establish and implement expectations around moral duty. Moral duty in medical care does not occur organically. On the contrary, it deteriorates organically. The directive, then, becomes clear. A gathering of component leaders must occur to define its medical care environment’s unique moral duty with a moral duty statement.
Assuming such a forum exists and that a gathering of leaders occurs, what, then, are the “ethical principles” that form the basis of the medical care environment’s moral duty? Again, every medical care environment has the right and responsibility to determine its own values. Those principles that locally assure patient well-being. That said, every medical care environment also shares similar challenges and must have strategies to deal with them.
Accordingly, a medical care environment’s moral duty statement typically addresses the following:
Standard of Care ⇢ The medical care environment has the moral duty to establish its standard of care. This means it has quality expectations for its doctors—expectations like board certification, analysis of patient outcomes, communication and online review of patient experiences. It has quality expectations for its hospitals—expectations like Joint Commission accreditation, Magnet Nursing designation, and safety of the clinical learning environment. The medical care environment requires payors to partner in responsible ways to maintain its quality standards—ways like value-based payment and pay-for-performance. Universities and industry actively participate to maintain the standard of care.
Providing Care for all Patients ⇢ The medical care environment has the moral duty to provide a plan that provides care for all, regardless of case complexity or ability to pay. Doctors must establish rules where they share in the care of the less fortunate and partner with other medical communities to refer complex cases. That might mean participation in rotational call schedules, free medical clinics or resident teaching clinics. Hospitals must do the same. Payors need to provide benefits to as many patients as possible. That might mean enrolling eligible patients into the appropriate governmental and private payment plans (e.g., Medicaid, hospital sponsorship, etc.). Universities must be ready to provide learners that enhance medical care and pharma must provide access to affordable drugs
Future Medical Care Workforce ⇢ The medical care environment has the moral duty to train the future medical care workforce. Medicine is a profession where experiential learning is essential for its future workforce. Thus, the environment must establish and maintain a robust, safe clinical learning environment. Doctors must be committed to teaching or committed to supporting colleagues who are committed to teaching. Oversight of learners to maintain patient safety is essential. Hospitals must optimize their clinical environment for teaching and research. Payors must provide appropriate enhanced reimbursement to support medical education at all levels and universities must provide optimally prepared learners entering the clinical learning environment.
Fiscal Responsibility and Financial Sustainability ⇢ Finally, the medical care environment has the moral duty of fiscal responsibility and financial sustainability. In other words, doctors, hospitals, payors and universities/innovators must make the dollars work for everyone. That includes the patients. Profit motive and greed have no place in the field of medicine. We all have a responsibility to hold each other accountable for our financial needs and those of the medical care environment.
America is experiencing a Medical Care Crisis. While it has the most resourced medical care environment with the best doctors, hospitals, and universities/innovators, it paradoxically also has the highest patient dissatisfaction in the world. An unbalanced medical care environment seems to be the blame. Patient well-being is no longer our “North Star.”
A lack of autonomy, self-governance and action in accordance with moral duty rather than self-interest, is a root cause for our imbalance. In fact, none of the four components (doctors, hospitals, payors or universities/innovators) are truly autonomous. They either lack self-governance or they seem to place self-interest before moral duty.
In short, moral duty makes patient well-being the standard and autonomy the key to solving the Medical Care Crisis.
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