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The Danger of a New Medical Care 'Bioethics'


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American Thinker:

The Patient Protection and Affordable Care Act (PPACA, ACA, or "Obamacare"), signed into law March 2011, in the near term creates more than 100 new health care bureaucracies, a large increase in taxes, and new government expenses of $500 billion. Most importantly, however, it will create an incentive and penalty regime for health care institutions and professionals that will compromise traditional professional medical ethics.

Embedded in PPACA is a system of mandates and incentives derivative of guidelines for efficient patient care that means some rationing. An example most often raising objections in the public discussion of PPACA is the Patient Centered Outcomes Research Institute, a part of the bill intended to address "end of life" resource utilization, but other entities created by the PPACA, such as the Independent Payment Advisory Board (IPAB), will promote care guidelines intended to reduce resource utilization or withhold care for patients based on guidelines composed for promoting resource efficiency.

The basis for the claims that Medicare costs will be reduced by hundreds of billions for the next decade is driven by the research of Jack Wennberg, M.D. of Dartmouth called the "Small Areas Analysis" that compares medical care in different parts of America to identify the least expensive practice patterns.

PPACA introduces a heavy emphasis on social engineering and state-imposed patterns for care and resource utilization. The major casualty will be the quality of the individual patient-physician relationship -- physicians will be incentivized and provided guidance and asked to become agents of a monolithic, centrally directed health care system to produce efficiencies in medical resource utilization -- that some would translate such developments as rationing.

American medical ethics traditionally has been Judeo-Christian and focused on the value of the individual with an emphasis on professionals' duty to the needs of the patient. The new ethics is, in contrast, utilitarian, the goal of utility measured in terms of societal, not individual benefit. The abstract concept of the good for society and for "utility" can often be in conflict with the ethical duty to the individual. snip
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