Is it unethical for physicians not to consider costs? – ctd.

I’ve been surprised by some of the pushback against my post on the the ACP manual of ethics. So I want to take some time to explain myself further. Let me make a few points:

1) One of the first things I learned as a writer is that if someone misunderstands what I’ve written, my first thought should not be that it’s the reader’s problem. I should always consider that I could have made my point better. So please stop telling me that I misunderstood them and to stop misunderstanding. I’m an engaged and intelligent reader, and if I didn’t get their point, I think they might want to make things clearer.

2) I did not pull a few sentences out of context. The text I drew from was a section entitled “The Ethics of Practice”. It’s page 86-87. I even quoted from a highlighted Box (#4), so they wanted that text to stick out.

3) This is a document about ethics. I take that very seriously. This is not an editorial, nor an exhortation about how physicians need to think or act. It’s not a comment about society or how we should make policy. It’s a manual telling physicians how to be ethical. The ACP chose to put the words “cost-effective” in an ethical document, in a section specifically dealing with clinical practice. Maybe that was the right decision. I’m not sure. But I think it’s worth discussing, and so I did.

4) I don’t think it’s a bad idea for doctors to consider cost-effectiveness when they talk to patients. I think it’s fine for patients to see that some treatments may be a waste of money, and they might want to save that money. But I’m not sure that I think it’s as great an idea for doctors to consider “health care resources” in the same way. I’m just not as comfortable with that. At least, not when we’re talking “ethics”. Is a physician who advocates for a treatment that’s not cost-effective acting unethically? Again, I don’t think that’s what the ACP intended. But most physicians likely won’t spend the time to read the whole document. Most won’t even look at the highlighted boxes. But some will. And the word “parsimonious“, meaning “extreme unwillingness to expend resources” or “frugal to the point of stinginess” is right there. I’m not sure that was a good idea in a manual of ethics.

5) I am a fan of the ACP. I don’t think badly of them. I don’t think they are evil or have ulterior motives. I’ve been a fan of theirs for longer than some of you have known who they are. And I’ll keep poking them with a stick. That’s how I show my love.

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