The De-Professionalization of Healthcare

One of the things that really bothers me in the field of contemporary healthcare has to do with Advanced Directives (AD) and their effect on the patient-professional relationship.

At face value, one might say, ADs are an expression of the desires of a patient regarding future healthcare interventions if and when the patient is unable to express those desires due to illness, injury or the natural process of death. They also give family members a clearer indication of a family member’s preferences or desires should the patient not be able to communicate them clearly in the moment.

The problem I have with them are these:

While patient consent to any medical procedure is sacrosanct, issuing future direction for feared situations may not be. Of great concern is the a good understanding of what motivates and develops patient consent. Similarly, patient directives as provided by ADs, are of great importance, but also of major significance is the process and motivation leading to those directives.

Secondly, medical personnel are not mere providers of services in a contractual sense. I get so frustrated with the current language prevalent in today’s medical world. Patients have become “customers” and we doctors, nurses, social workers and others are “providers of service.” The business mentality has infiltrated American medicine. Medical personnel have become individuals who provide a service that is “purchased” by our “customers.”  This is a the great de-professionalization of healthcare. We no longer are as free as we once were, (and  we are losing more and more of what freedom remains), to act in the best interests of our patients. 

This sets up real moral and ethical problems. My patient may want me to perform or withhold certain interventions that clearly are not in the best interest of his or her health and life. My patient may believe they are paying for my assistance, and demand I comply with their wishes even though to do so would  violate basic ethical or professional standards of care. No professional should be obligated to comply with such requests. To do so renders the medical professional a technician or a craftsperson, but not a person of profession.

The patient-professional  relationship is  a covenanted relationship, not a simple contractual one. It is based on a deep conviction that one is obligated to treat the person with respect and to act based on the spiritual/ethical bases for engagement of the individual.

I strongly suspect that if more doctors, nurses, social workers and others practiced their professions from covenanted commitments to their patients, these concerns would evaporate.

The problem in healthcare does not lie with the patients, as much as we would like to blame them. The problem is not that there are too many sick people that we can’t afford to treat. The problem is not that the elderly are consuming too many of our healthcare dollars in the end stages of life.

The problem is that we healthcare professionals have more and more abandoned our sacred covenant with the sick. We are caving into the power of the dollar. Not only are the sick endangered, but we give away our professionalism.

We have more than enough money to do this right. Just stop fighting a war or two.

But nowadays, with the paucity of good liberal arts education that includes philosophy and theology, and with the erosion of the experience of covenant in other areas of life, words like covenant are treated with scorn.

God help us!