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It is posited that the most ethical reason for a person to become a doctor is out of a genuine altruistic desire to help people, in contrast to because it is a profession which pays well. Therefore is a doctor who doesnt help people who cant afford to pay unethical? Is it unethical for a doctor to accept monetary payment for services from the poor?

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    Interesting, this is actually somewhat close in a way, although somewhat inverted, to a question we had a little while ago about whether it was ethically obligatory to become a doctor... – Joseph Weissman Jul 4 '14 at 22:41
  • why is it unethical to want money for ones craft? – Lukas Jul 5 '14 at 10:41
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    @Lukas Because such a requirement might directly (through inaction) lead to suffering/death? – coleopterist Jul 8 '14 at 10:04
  • It depends on what you think is moral obligated. Your inaction leads to suffering right now, because you could donate almost all your money to people in need. Are you obligated to donate? I would say no, you seem to lean towards yes. – Lukas Jul 8 '14 at 10:30
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    The question that Joseph is referring to is this one; Kaj_Sotala's answer there is very relevant. – Xodarap Jul 10 '14 at 20:19
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My perspective is as a family medicine doctor in training. Yes, I do find it unethical for doctors to refuse patients who cannot pay on the basis of increasing profits.

I work in several underserved, safety-net clinics and hospitals that take all patients regardless of ability to pay. This is my career choice because I want to contribute to the solution of our broken system.

These clinics have social workers and financial advocates that help uninsured patients try to get insurance or financial support to cover costs and allow them to get consistent healthcare. These clinics receive some funding from the government as well. None of these practices become filthy-rich, regardless if they are private or state or university-based. The practitioners are paid well, but not as much as in a private practice owned by the physician(s) who charge what they want and only take the insurances they want, rejecting anyone uninsured who can't pay up front.

These income-driven physicians are pushing their self-pay (uninsured) patients towards the "safety-net clinics," causing these clinics to carry a high % of the burden of uninsured patients while receiving fewer insured patients to recover costs. That imbalances the distribution of reimbursement to practices.

If there were limitless numbers of providers and clinics, it would be a minor issue.

But there is very limited space in medical schools and residency training programs. There is a primary care physician shortage in the tens of thousands and rising. These profit-driven physicians are taking up spots in training programs that could instead be taken by people willing to accept a good (but not exorbitant) income while investing in balancing and improving the system, rather than just draining the profits of it.

So in summary, yes I do find it unethical. But that is largely because it's in the setting of a broken, ineffective healthcare system (especially the insurance system) that drives costs excessively high and makes access to quality care a commodity, rather than a human right.

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I see three questions here, so lets take them one by one:

is it unethical for a person to become a doctor because it is a high income profession?`

Your system of ethics (e.g.: utilitarianism) might have either yourself or money ranked higher that helping others, so it can be perfectly ethical.

Therefore is a doctor who doesnt help people who cant afford to pay unethical?

If you take traditional deontological or christian approach - yes its unethethical.

is it unethical for a doctor to accept monetary payment for services from the poor?

Now for accepting .. i think there is nothing bad in it, unless your ethical system considers money to be evil.

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Considering the work of Hayek, one could argue that it is in fact ethical for a person to become a doctor because of the high wages.

Hayek thought about where prices for goods and services came from, and he was of the opinion that we should think of prices in a functioning market economy as a signal of what society needs - higher prices indicating that we need more of something, lower prices indicating that we need less of something. Thus, the high wages for doctors indicate we may need more of them.

Of course, this may not quite be true - there are all sorts of other reasons why wages for doctors (and other professions) have higher wages than society would normally dictate - limiting the number of doctors through licensing, the fixed costs involved in setting up a hospital or private practice, and so on. In some cases, the wages may be high due to these artificial constraints.

  • On a sidenote: Hayek is for abolishing these artificial constraints – Lukas Jul 8 '14 at 10:32
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Your idea that it is good to become a doctor out of a desire to help people rather than to make money is wrong. I will give a few criticisms of this idea.

  1. A desire to help people doesn't imply competence. If a person just wants to help people and can't get much money for doing it, he should consider the possibility that he isn't much good at it.

  2. The idea that it is wrong for you to benefit from doing stuff, e.g. - by getting money, is also wrong. Why would doing medicine be worse just because you benefit?

  3. It costs the doctor money every time he treats a patient for free so at least one person is worse off every time he does that, which is a criticism of doing it.

  4. If a person is too poor to afford medical services then he may be doing something wrong that he should correct. Providing medical services for free would make it easier for him to keep fooling himself.

  5. Somebody else may be responsible for medical services being expensive, e.g. - government policy. In that case, it is not the doctor's responsibility to give out freebies to take up the slack for another person's incompetence. And again, doing so would blunt the impact of that incompetence and so make it easier for the other person to fool himself.

  6. If the doctor is overcharging by choice, the overcharging is the problem, not the fact that he accepts money at all. He will miss out on some money he could get by charging less. His flaw leads to him making less money, not more.

For more general commentary on selfishness and altruism see http://aynrandlexicon.com/lexicon/altruism.html.

  • Point 4: "would make it easier [for] him"? – coleopterist Jul 7 '14 at 16:23
  • I don't see how this is an answer. Point 4: "may be doing something wrong" implies that he may also not be doing something wrong and still can't afford it. What's your answer then? – alfred Jul 14 '14 at 9:54
  • If the poor person is not doing something wrong what are the other options? One might be that somebody is stealing from the poor person or ripping him off in some respect. That is not the doctor's responsibility and so there is no reason why he should stop charging to make up for it. Other possibilities include points (5) and (6), which I have already answered. Do you have some other objection in mind? – alanf Jul 14 '14 at 10:05
  • ...I'm not sure why you assume that because a poor person can't afford something, there must be some sort of shady reason for it. And why do you believe medical services would be naturally affordable to the poor in a free market? If you see someone drowning in a lake, it's not your fault, but it's still your responsibility to help the person if you're able to. If your answer is to simply let the poor person die, don't be surprised if other people don't take your philosophy seriously. – alfred Jul 14 '14 at 10:31
  • I didn't say there was anything shady about the poor person's actions. Actions can be wrong without being shady. For example, he may be bad at his job because he has bad ideas about how to learn so that he doesn't get promoted. Now, he might still get the money by asking for a loan against his future income or asking for charity. If he fails at all such attempts then he is doing something wrong, e.g. - not explaining his case well. – alanf Jul 14 '14 at 11:31
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Is it unethical to become a doctor when you are actually not very good at it and cause harm to your patients? Surely yes. Is it unethical if you are a bad doctor to not bother improving but continuing to cause harm to patients? Yes as well.

Now your motivation why you become a doctor doesn't matter. What matters is whether you help people or not. If one person is a greedy soandso who actually helps his patients, and another is only trying to help and doesn't care about money but makes things worse for his patients out of incompetence, the greedy but good doctor is acting ethically, while the selfless incompetent is unethical.

Now about treatment for people who cannot afford treatment... Three obvious solutions are either that the doctor treats them for free, that a charity collects money to treat them, or that the state collects taxes to pay for treatment (ignoring the possibilities that poor people could either rob banks to pay for treatment, or just lay down and die). Why should a small number of people (either doctors, or particularly nice people donating money) pay out and not everyone? Especially since the nice people (doctors, people donating money) end up being worse off than those who don't care about the health of poor people?

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Choosing one profession over another because you will make more money, cannot be unethical. There is no obligation for one to sacrifice ones potential benefits, for the benefit of others. For doctors (lawyers, mechanics, etc.) with different competencies, it would be unethical for the less competent person to charge the same as the most competent person.

If you don't have the aptitudes to be a doctor (lawyer, etc.), and you cheat or "pay" to continue and get a diploma, just because you will get your "investment" back, that would be unethical ( on several grounds).

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