Morals, Medicine and Medical Economics!
September 10, 2014
Medicine is full of moral questions. When I worked as a family doctor I had to make decisions almost everyday on issues:
- Sally is a 14-year-old whose mother wants her to have an abortion, but she is frightened and thinks it is wrong to kill the baby.
- John is presenting with back pain but really just wants me to provide him a “sick note” for a couple of days so that he won’t lose salary to take a few days off while he helps his brother-in-law with a repair to the house.
- Helen is under a lot of stress because of family tensions including a teenager at home that is on drugs. Please can I just give her some Valium (or Prozac or whatever else is the drug of choice) to help her cope?
How do you find a clear moral compass to help answer the challenging dilemmas that are part of modern life?
Everyone lives with their own concept of right and wrong, whether they identify themselves as being “religious” or not. It seems to be a part of the human condition that we all have a conscience shaped by our background, our families, and the role of faith (whether in God or in nothing!) in our lives.
Within Sedera Health, we recognize the influence of these moral issues. We do not presume to tell anyone what they should believe, or how they should live, but we do acknowledge that choices have consequences, including economic consequences.
For example, we welcome smokers as a part of our program. Smoking has nothing to do with right or wrong, but it has everything to do with how much illness we are likely to experience. And so helping deal with the cost of smoking-related diseases does have a moral component. Are we going to force non-smokers to share the cost of these illnesses in their smoking friends, even though the non-smoker has a greatly reduced risk of illness?
One way to handle this, which is what insurance companies usually do, is to charge a higher premium to smokers. Nobody would see anything wrong with this approach as far as I know. It is interesting to note that as a society we have come to terms with the direct correlation between smoking and health and charge the smoker for this. Yet we still struggle with obesity and are more hesitant to charge the obese for the many illnesses that are directly related to their choices.
Part of this difficulty is our lack of a clear moral compass.
Within Sedera, we have gone a different route. We decided that we would not share within our benevolence program, the cost of the most common smoking related illnesses for smokers who choose to be in our program. Because of this, some smokers may choose not to be a part of Sedera Health and may prefer the approach of the insurance companies through the Exchanges. Others, seeing the savings that they can have through Sedera may make the hard decision to quit smoking. And we will do everything we can to help them. Similarly, we are looking at everything that we can do to help those who are overweight, so that they can enjoy the blessing and results of healthier lifestyle choices.
Clearly actions have consequences.
Jesus was an amazing reformer and challenger of the status quo, including the religious status quo. For example, his attitude to women, and the respect that he showed them in the most challenging of circumstances, was hardly normal within the Jewish community of his day.
Many of us within the leadership team of Sedera Health choose to allow the values that shaped Him to also shape us.
For myself, as an open follower of Jesus, this is what has shaped my desire to create a methodology where the benefits and rewards of good choices could be made available to all people, not just to people of faith.
We welcome people of all faiths or of no faith. But we do this within the context of the whole Sedera Health community of members, each one understanding that a part of our responsibility in belonging to this community is to accept the personal responsibility for our own health care choices.
We would love to hear what you think about this stance?
Dr. Tony Dale | @tonydaleaustin | @sederahealth