First critique of Buchman and Chalfin's analysis

Abstract

Buchman and Chalfin note heterogeneity in how physicians view their obligations to individual patients and society. They correctly note that the traditional Hippocratic view is that physicians should do all they can to advance the interests of their individual patient. However, it is not clear that physicians should or actually do adhere to the Hippocratic vision in modern, publicly funded health care systems. Healthcare rationing involves withholding potentially beneficial treatments from individuals on the grounds of scarcity [1]. Because the population need for healthcare goods is virtually limitless, rationing is unavoidable [2]. Moreover, in most developed countries, healthcare draws its funding from the same public pool as other social goods such as education, infrastructure, environmental protection, and defense. Therefore, healthcare's share of resources often grows by proportional cuts in other social programs. As a consequence, when healthcare is at least partially publicly funded-as it is in the United States and most other industrialized nations-the public good becomes an ethically relevant consideration when assessing physicians' obligations to individual patients and to populations of patients. This essay is limited to such contexts.