Medical ethics is pretty much extinct. The decision has been made “from above” to detach liability for good care from the system, and place it upon the patient’s shoulders. Let the buyer beware! is the new theory of Medical Savings.
Hindus in the Indian Army were reluctant to kill, so one person was the weapon loader, and one person was the trigger-puller. Oh, gosh – there was a ROUND in that rifle! Not my fault, says one. I just load them, says the other. We note that what has disappeared from the Army is Hindu ethics, not killing. Nobody in the modern Indian Army would get away with that pro-life stuff.
I had an elderly patient with mobility impairment and pelvic pain. I was concerned enough about mets from some occult cancer to send him for an X-ray. The discount x-ray facility is 30 miles away, so I put in for a local x-ray in my town, less than four miles from the clinic. It was denied.
Now, he has the option of not getting the film done, or driving to the far-away discount facility. The latter is not a reasonable option. Therefore, his order for the X-Ray will be marked as “lapsed” and the patient is “noncompliant.”
That’s really satisfactory to the bureaucrats. It saves money. But what if it’s a met, as I’ve seen in other elderly people? My chances of getting something done locally might be higher if I order a local MRI, and it would be more likely to inspire approval. But what’s most likely to happen is that he will quietly slip through the cracks.
In tort law days of old, physicians used to be legally responsible for reasonable diagnosis. Missing an obvious study would be grounds for legal complaint. Now, the choice is handed back to the patient – here, you, zip down to Discount Dan’s x-rays. You can’t do it, old-timer? YOU WON’T do it, that’s more likely. And the liability falls on Pops.
Dumping liability on the customer is the HUGE moneymaker in the New Medicine. Risk is expensive, and insurance companies survive by dumping risk. Here’s one more of corporate medicine. If anyone gets blamed, it’s going to be the doctor who “missed the diagnosis.” But nobody will squawk, nobody will sue, Pops will go under six feet, and the charade will continue.
Who’s wielding the moral vision? Technically, the company far, far away. Actually, nobody. “Oh, gosh – there was a MET in that pelvis!” Too bad, so sad, Pops.