Tavistock "Shared Ethics" --- A Slippery Slope

Editorial

Tavistock "Shared Ethics" --- A Slippery Slope

Miguel A. Faria, Jr., MD

The "shared ethics" espoused by the Tavistock Group reflect a growing collectivist attitude toward medical ethics that is destroying our profession piecemeal (" 'Shared Ethics' for all providers a Quixotic quest," Internal Medicine News, March 1, 1999, p. 5).

The medical ethics of Hippocrates are based on the individual, but groups such as Tavistock embrace a collectivist morality in which individual rights take a back seat to the rights of society, government, and insurers.

A colleague who served on a medical ethics committee of his internal medicine subspecialty consulted me regarding guidelines on the initiation, continuation, and withdrawal of intensive care.

What I found, sadly, was that every other paragraph in the voluminous package of material he sent me had the potential to lead to the transmutation of the individual-based, medical ethics of Hippocrates to a corporatist, collectivist morality. Health care then becomes a "right" and ethics become "shared." The material he enclosed for me led subtly from rational allocation of resources to euthanasia.

I warned him against what I perceive to be a potential societal trend in which physicians could become the instruments used to carry on a social agenda of rubber-stamping policies that lead to the de facto rationing of medical care. Some ethicists, such as Dr. John Hardwick of East Tennessee State University, have dropped all pretenses about these proposals. They have gone ahead and called this issue an agenda leading up to "a duty to die."

The ethics of Hippocrates state that the doctor must place the interest of patients first, above monetary considerations or his own self-interest when acting within the purview of the patient-doctor relationship.

The doctor must also reject utilitarian ethics. He or she must place the interest of the individual patient above that of the collective, be that the third-party payer, the health network, or more lofty-sounding entities such as society, the state, or the "greater good."

To do otherwise is the first step down a slippery slope.

Under collectivist and authoritarian states, the government takes utilitarian and pragmatic approaches to "ethics": what is useful is good and what is done for the good of the people as a whole, rather than the benefit of individuals, is best.

Before the Nazis came to power in Germany, the Weimar Republic (a social democracy) paved the way for rational, utilitarian ethics of "the proper allocation of resources." As early as 1931, German physicians openly held discussions about sterilization of undesirables and euthanasia of the chronically mentally ill.

Dr. Leo Alexander, a distinguished psychiatrist and the Chief U.S. Medical Consultant in the Nuremberg War Crimes Trials, wrote a momentous article (N. Engl. J. Med. 1949;243(2):39-47) in which he described how German physicians became willing accomplices with the Nazis in "ktenology," the science of killing for the "good of German society" and the improvement of "the health of the German nation."

Under the utilitarian ethics of rational allocation of resources and the "benefits of society," Hitler issued his first order for euthanasia in Germany on September 1, 1939, as his Panzers moved on Poland. Groups with humanitarian-sounding names were set up for "health" programs under deceptively euphemistic terms. And so, even before the Holocaust was officially implemented, 275,000 German citizens were put to death.

An aberrance, you say? It could never happen here?

Dr. Alexander wrote that "from small beginnings" the values of an entire society may be subverted, and "it is the first seemingly innocent step away from principle that frequently decides a life of crime. Corrosion begins in microscopic proportions."

The move to transmute our traditional, individual-based ethics of Hippocrates into the utilitarian "shared" ethics espoused by business groups is the first step down that slippery slope. As physicians, we must resist the urge to take it.

Miguel A. Faria, Jr., M.D., Editor-in-Chief, Medical Sentinel. Reprinted from Internal Medicine News, May 15, 1999.