Moral Choice and Public Policy

Moral Choice

The physician-patient relationship is at the heart of what it means to generate ethical medical decision making. The physician has many roles, including those of a technician, wage earner or entrepreneur, agent of public well-being, and advocate for public policy. These roles, however, do not constitute what it means to be a professional and a physician. What a physician professes, and that which is at the root of this relationship, is that the physician is obligated to place the welfare of the patient above all other considerations. This role as a healer remains as the irreducible character trait of the physician and is the moral foundation for ethical medical decision making. Note that the role of healer goes beyond that of technician to the body human because it encompasses consideration of the person's spiritual well-being also.

A second aspect of moral choice in medical decision making has been guided by the paradigm of patient autonomy. This view holds that the final authority for determining the treatment and direction of a patient's medical care lies with the patient or the patient's surrogate. The exercise of that right creates a responsibility for the physician to provide that the patient, or the patient's surrogate, is sufficiently informed and the resulting decisions are not coerced and are free of undue stress and self-interest. Furthermore, decision-making capacity is a developmentally regulated process, and among the determinants of that capacity are the age and developmental status of the individual, his or her relative health, the nature of the choice to be made, and the stress under which that person finds himself or herself. As this applies to ethical decision making in public policy, this would entail that decision making in the public arena requires an informed populace that is able to have an input into decisions made on their behalf. This input should be solicited in a noncoerced way that is free of undue stressors. Finally, not all decisions in healthcare carry a moral imperative. Certain questions, such as the appropriate antibiotics, are a technical matter, and other moral questions, such as priority listing for patients requiring solid organ transplantation in a country without the resources to perform such procedures, are not at issue on solely circumstantial grounds.

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