Big Business and Morality in Medicine

Big Business and Morality in Medicine

By Eugen Schoenfeld

Today’s economic practices of profit making, from accumulated capital and business transactions, have become disassociated from the moral base of the past.

The moral underpinning of economics is associated with the Torah’s proscriptive moral laws on usury. The Torah, for instance, forbids taking advantage of those who are economically disadvantaged and those who lack the ability to gain the wherewithal for a chance at life.

The Torah specifies that if your brother becomes poor, you should extend your hand to him. The moral laws associated with poverty also prescribe that if the poor leave their tools or bedding as security for a loan, the lender must give them back in the morning so that the borrower may earn income with his tools and get appropriate rest on his bedding.

In short, business transactions from the Torah’s perspective have always been guided by a moral order that protected the rights of the poor.

Emile Durkheim, in his treatise on the social division of labor, was influenced by the Torah; after all, he was the son of the chief rabbi of Alsace-Lorraine. Durkheim proposed that an agreement between two individuals is not a morally valid contractual relationship if one party has power over the other and uses it to gain an advantage.

In Max Weber’s view, the roots of modern capitalism reside in the Calvinist concept of the work ethic: hard work, frugality and moral relationships. Calvinism also teaches a particular sense of morality because money one accumulates and uses in business belong to G-d, so the use of the money must be governed by moral teachings.

Weber wrote that the Calvinist idea that people are duty-bound to labor is a calling, and all such activities are to be governed by a moral obligation to G-d. That is, Protestantism brought into the marketplace the idea that economic activities are not purely secular activities outside moral obligation.

Unfortunately, neither the biblical teaching nor the Protestant ethic retained the moral component in modern capitalism.

When Weber visited the United States in 1904, his observation of our economic system led him to declare: “In the United States, the pursuit of wealth stripped of religious and ethical meaning tends to become associated with purely mundane passions, which actually gives it a characteristic of sport.”

Have we indeed become a nation without a morally based economic system? Have we relegated our economy purely to the dictum “Get all you can get”?

Has that idea become so pervasive that we reject the once-common view that medicine has an intrinsic commitment to human life and is an activity based on moral underpinnings and endowed with an aura of sanctity and high esteem?

What happened to the image of the caring physician? What happened to our view that health is a collective concern?

Most important, should ownership of medical knowledge and health-giving pharmacology be like all other businesses, subject to the same extrinsic amoral laws that govern the selling of a car? Should medicine become like other secular capitalist businesses, committed only to making money?

Or should we insist that the task of healing the sick is a collective interest and must be subject to moral scrutiny?

A half-century ago, Lawrence Kohlberg began his studies on the subject of moral development. Influenced by his Jewish learning, Kohlberg considered morality to be rooted in the principle of justice.

Like our ancient prophets, Kohlberg sought to understand how people develop a sense of morals and what differentiates those who have a low level of moral convictions from those who a high one.

Kohlberg tells us that those who adhere to moral primitivism are by nature selfish, concerned only with their interests, and they adhere to ideals only in response to the fear of punishment.

In contrast, those he considers to have the highest moral standards are committed to universal morality as a matter of justice. To him, high moral standards are exemplified by the view that central to universal morality is the right of all people to have equal access to conditions that provide a chance to live.

Kohlberg constructed a story, known as the Heinz dilemma, and the responses to the story provide an indication of a person’s level of moral development. In a way, the Heinz story to me is a variation of the story that the prophet Nathan used to confront King David’s immorality. It is a story reflecting moral justice.

Heinz was a hardworking man whose wife was stricken with cancer. A pharmacist in his city developed a cure for the disease. Heinz went to the pharmacist, seeking to buy the drug and thus to save his wife’s life.

The pharmacist was willing to sell him the drug for $10,000, but, alas, even though Heinz sold all his possessions and borrowed from friends all that he could, he was unable to raise even half the required amount.

The pharmacist was adamant in his demand for the full price for the drug. He felt that he developed the drug and thus could charge any amount that he wished for it.

That evening Heinz entered the pharmacist’s domain and attempted to steal the drug. Heinz was caught.

Was Heinz guilty? Did he deserve punishment? Was the pharmacist equally guilty?

When it comes to the saving of a life or the reducing of pain, what should be our moral stance? Is the saving of a life more important than the making of a fortune?

In our world, at least in the United States, the pharmacy business has entered a moralless stage of capitalism. Medical care has become morally equivalent to the selling of illicit drugs.

Because of the tremendous rise in medical costs, access to life has, more than ever, become differentiated between the haves and have-nots.

Life in all its aspects is a function of affordability now, but we still call ourselves an advanced society. I sometimes wonder, especially after the last election, whether we have retrogressed to the standards of Sodom and Gomorrah.

What do you think?

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