Un “viejo” trabajo del maestro Pellegrino

Este es un trabajo para leer y releer, y también para enviar a los “especialistas en economía de la salud”…

The Commodification of Medical and Health Care: The Moral Consequences of a Paradigm Shift from a Professional to a Market Ethic
Edmund D. Pellegrino

Commodification of health care is a central tenet of managed care as it functions in the United States. As a result, price, cost, quality, availability, and distribution of health care are increasingly left to the workings of the competitive marketplace. This essay examines the conceptual, ethical, and practical implications of commodification, particularly as it affects  the  healing  relationship  between  health  professionals  and  their  patients.  It  concludes that health care is not a commodity, that treating it as such is deleterious to the ethics of patient care, and that health is a human good that a good society has an obligation to protect from the market ethos.

Entre otras cosas, Pellegrino dice:

… health, or at least freedom from acute or chronic pain, disability, or disease, is a condition of human flourishing. Human beings cannot attain their fullest potential without some significant measure of health. A good society is one in which each citizen is enabled to flourish, grow, and develop as a human being. A society becomes good if it provides those goods which are most closely linked to being human. Health care is surely one of the first of these goods. It is, to be sure, not the only human  good  (Aristotle,  Nicomachean  Ethics,  1178b30–34).  But  other goods,  like  happiness,  wealth,  friends,  career,  etc.,  are  compromised  or even impossible without health.”

Y termina:

“This is not the place to design a total system of health care, nor to fill in the content of precisely what services constitute a fair share of the common good of health care, nor to speak of the costs, modes of payment, and choices  among  other  societal  goods.  Obviously,  those  are  the  questions most often at issue in policy debates. But, in the end, those are second order questions. They can be answered properly only in light of the first-order questions: What is health care? What kind of good is it? What moral claim  do  members  of  a  society  have  on  this  good?  What  are  society’s obligations, and what are the obligations of the health professional with reference to that good?
Understanding health care to be a commodity takes one down one arm of a bifurcating pathway to the ethic of the marketplace and instrumental resolution of injustices. Taking health care as a human good takes us down a divergent pathway to the resolution of injustice through a moral ordering of societal and individual priorities.
One thing is certain: if health care is a commodity, it is for sale, and the physician is, indeed, a money-maker; if it is a human good, it cannot be for sale  and  the  physician  is  a  healer. Plato’s  question  admits  of  only  one ethically defensible answer.
Can we deny, then, said I, that neither does any physician, insofar as he is a physician, seek to enjoin the advantage of the physician but that of the patient?
(Plato, Republic 342c)”

Journal of Medicine and Philosophy, 1999, Vol. 24, No. 3, pp. 243–266

Accesible en http://jmp.oxfordjournals.org/content/24/3/243.full.pdf+html



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