Braithwaite S S
Section of Endocrinology and Metabolism, Loyola University, Chicago Stritch School of Medicine, Maywood, IL.
J Clin Ethics. 1993 Summer;4(2):124-33.
This article argues for a prohibition on the courtship of the paying patient by individual practitioners, groups, institutions, and corporations. Our society fails to provide universal access to health care. While we await societal resolution, the private provider retains partial responsibility for addressing issues of distributive justice. All private physicians, groups, institutions, and corporations should offer a fair share of underreimbursed, nonemergency care. If economic survival or beneficent economic commitments of a provider are at risk, the provider may explicitly limit underreimbursed services by a rational system of accepting or rejecting nonemergency, indigent patients. The system should be one that, if implemented by all providers, would meet regional societal needs. One might analyze the issue of courtship of the paying patient as a problem of distributive justice. The desire of paying patients to receive personalized care or nonmedical amenities and to have the freedom to buy the best possible medical care, and the economic interests of the providers (the desire of the already affluent provider to seek further gain and growth, the need of a threatened provider to survive, and the dependency of educational institutions on patient payments) all conflict with distributive justice. The marketing interest of providers conflicts with the greater need of the poor to receive information about health, and it conflicts with public need for protection against misleading solicitation. The possibly higher per capita cost of treating the poor, along with possibly lower success rates, create a conflict between cost-effective allocation of limited resources, on the one hand, and egalitarian distributive justice, on the other. The competitive market principle may even protect, rather than defeat, the principle of justice. The author, however, writing from the point of view of the physician, has analyzed the question in terms of a conflict between the economic interest of the physician (perhaps as agent of his group, institution, or corporation) and the trustworthiness of the profession. The courtship of the paying patient represents a failure of the professional virtues of truthfulness, loyalty, and respect for persons.
本文主张禁止个体从业者、团体、机构及公司对付费患者进行拉拢。我们的社会未能实现医疗保健的普遍可及。在等待社会解决这一问题的过程中，私立医疗服务提供者仍需承担部分解决分配正义问题的责任。所有私立医生、团体、机构及公司都应提供合理份额的低补偿非紧急医疗服务。如果医疗服务提供者的经济生存或慈善经济承诺面临风险，该提供者可通过合理的接受或拒绝非紧急贫困患者的系统，明确限制低补偿服务。该系统应是一种若所有提供者都实施就能满足地区社会需求的系统。人们可能会将拉拢付费患者的问题分析为分配正义问题。付费患者希望获得个性化护理或非医疗便利设施，并能自由购买尽可能优质的医疗服务，而医疗服务提供者的经济利益（富裕的提供者寻求进一步获利和发展的愿望、面临威胁的提供者求生存的需求以及教育机构对患者付费的依赖）都与分配正义相冲突。医疗服务提供者的营销利益与穷人获取健康信息的更大需求相冲突，也与公众防范误导性招揽的需求相冲突。治疗穷人可能更高的人均成本，以及可能更低的成功率，一方面在有限资源的成本效益分配与另一方面的平等主义分配正义之间造成了冲突。竞争市场原则甚至可能保护而非违背正义原则。然而，作者从医生的角度出发，将这个问题分析为医生（或许作为其团体、机构或公司的代理人）的经济利益与职业诚信之间的冲突。拉拢付费患者体现了诚实、忠诚和尊重他人等职业美德的缺失。
