Hoffman Wendell W
Sanford Clinic - Infectious Disease, Sioux Falls, South Dakota.
University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2020 Jan;73(1):22-31.
"Privilege" vs. "Right" in healthcare is a failed political binary because it has divided the nation. The "my privilege" end of this false choice has been damaging, shifting the burden to the patient and away from the physician. It is medicine's historic privilege to care for any human but obligation has waned being plagued by opportunism. Also, what we have a right to or are privileged to receive is undefined. Past premises for the privilege are untrue, based on Health = medical care. Present assessments of the privilege are unfair, deeming American medicine a sickness. Future solutions for the privilege are untenable, if "equality" is the goal. The framework for healthcare's obligation-to-give already surrounds us, emerging from the American Revolution with its idea of individual dignity as to priority, checks and balances as to protection and Federalism as to improvement. American medicine has followed this idea albeit misused and unfulfilled. The null hypothesis of this debate must be fairly tested - that American medicine is the worst form of healthcare delivery - except for all the rest. Both Big Business and Big Politics in healthcare have become ends unto themselves and therefore neither can solve the privilege question nor bear the weight of our obligation-to-give. The patient-as-obligation must be our aim.
医疗保健中的“特权”与“权利”是一种失败的政治二元对立,因为它分裂了国家。这种错误选择中“我的特权”一端具有破坏性,将负担从医生身上转移到了患者身上。照顾任何人是医学的历史特权,但由于受到机会主义的困扰,这种义务已经减弱。此外,我们有权或有特权获得的东西尚无定论。过去关于特权的前提是不真实的,基于健康=医疗护理。目前对特权的评估是不公平的,将美国医学视为一种弊病。如果“平等”是目标,那么未来关于特权的解决方案是站不住脚的。医疗保健给予义务的框架已经在我们周围出现,它源自美国独立战争,其理念是以个人尊严为优先,以制衡为保护,以联邦制为改进。美国医学遵循了这一理念,尽管被滥用且未得到充分实现。这场辩论的零假设必须得到公正检验——即美国医学是最糟糕的医疗服务形式——除了其他所有形式。医疗保健领域的大企业和大政治都已成为自身的目的,因此两者都无法解决特权问题,也无法承担我们给予义务的重担。以患者为义务必须是我们的目标。