Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-28T04:01:14.273Z Has data issue: false hasContentIssue false
  • English
  • Français

Saving and Ignoring Lives: Physicians’ Obligations to Address Root Social Influences on Health—Moral Justifications and Educational Implications

Published online by Cambridge University Press:  18 August 2010

JOHN R. STONE
Get access Rights & Permissions [Opens in a new window]

Extract

The predominant influences on health are social or upstream factors. Poverty, inadequate education, insecure and toxic environments, and inferior opportunities for jobs and positions are inequitable disadvantages that adversely affect health across the globe. Many causal pathways are yet to be understood. However, elimination of these social inequalities is a moral imperative of the first order. Some physicians by word and deed argue that medical doctors should oppose the “structural violence” of social inequalities that greatly shorten lives and wreak so much suffering.

Type
Special Section: Bioethics Education
Information
Cambridge Quarterly of Healthcare Ethics , Volume 19 , Issue 4 , October 2010 , pp. 497 - 509
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Marmot, M, Friel, S, Bell, R, Houweling, TA, Taylor, S, Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet 2008;372(9650):1661–9CrossRefGoogle Scholar; Marmot, MG, Bell, R. Action on health disparities in the United States: Commission on social determinants of health. Journal of the American Medical Association 2009;301(11):1169–71.CrossRefGoogle ScholarPubMed

2. Adler, NE, Rehkopf, DH. U.S. disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health 2008;29:235–52.CrossRefGoogle Scholar

3. Farmer, P. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press; 2003, e.g., at p. 255Google Scholar.

4. Geiger, HJ. Health disparities. What do we know? What do we need to know? What should we do? In: Schulz, AJ, Mullings, L, eds. Gender, Race, Class, & Health: Intersectional Approaches. San Francisco: Jossey-Bass; 2006:261–88Google Scholar.

5. Wynia, MK, Latham, SR, Kao, AC, Emanuel, LL. Medical professionalism in society. New England Journal of Medicine 1999;341:1612–16CrossRefGoogle Scholar. (Note that page numbers for following quotations are not available in electronic version—my source.)

6. Cruess, RL, Cruess, SR. Expectations and obligations: Professionalism and medicine’s social contract with society. Perspectives in Biology and Medicine 2008;51(4):579–98CrossRefGoogle ScholarPubMed.

7. Stone, JR. Healthcare inequality, cross-cultural training, and bioethics: Principles and applications. Cambridge Quarterly of Healthcare Ethics 2008;17(2):216–26CrossRefGoogle ScholarPubMed.

8. ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine 2002;136(3):243–6 at p. 245CrossRefGoogle ScholarPubMed.

9. Powers, M, Faden, R. Social Justice: The Moral Foundations of Public Health and Health Policy. New York: Oxford University Press; 2006, e.g., at p. 57Google Scholar.

10. Daniels, N. Just Health: Meeting Health Needs Fairly. New York: Cambridge University Press; 2008Google Scholar.

11. See note 6, Cruess, Cruess 2008.

12. Reeve, A. Contract. In: McLean, I, ed. The Concise Oxford Dictionary of Politics. New York: Oxford University Press; 1996:110–1Google Scholar.

13. Hampton, J. Social contract. In: Audi, R, ed. The Cambridge Dictionary of Philosophy. New York: Cambridge University Press; 1995:745–6Google Scholar.

14. Hampton, J. Political Philosophy. Boulder, CO: Westview Press; 1997Google Scholar.

15. Rawls, J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1971Google Scholar.

16. Rawls, J. Political Liberalism. New York: Columbia University Press; 1996Google Scholar.

17. Kymlicka, W. Contemporary Political Philosophy: An Introduction. 2nd ed. New York: Oxford University Press; 2002Google Scholar; Benhabib, S. The Claims of Culture: Equality and Diversity in the Global Era. Princeton, NJ: Princeton University Press; 2002Google Scholar.

18. See note 14, Hampton 1997.

19. See note 6, Cruess, Cruess 2008.

20. Baker, R. The American medical ethics revolution. In: Baker, RB, Caplan, AL, Emanuel, LL, Latham, SR, eds. The American Medical Ethics Revolution: How the AMA’s Code of Ethics Has Transformed Physicians’ Relationships to Patients, Professionals, and Society. Baltimore, MD: The John Hopkins University Press; 1999:17–51Google Scholar; Wynia, MK. The short history and tenuous future of medical professionalism: The erosion of medicine’s social contract. Perspectives in Biology and Medicine 2008;51(4):565–78CrossRefGoogle ScholarPubMed.

21. See note 6, Cruess, Cruess 2008.

22. Caelleigh, AS. The social contract. Academic Medicine 2001;76(12):1174CrossRefGoogle ScholarPubMed.

23. Levi, J, Juiliano, C, Richardson, M. Financing public health: Diminished funding for core needs and state-by-state variation in support. Journal of Public Health Management and Practice 2007;13(2):97–102CrossRefGoogle Scholar.

24. Becker, LC. Reciprocity. Chicago: University of Chicago Press; 1986Google ScholarPubMed; Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, 6th ed. New York: Oxford University Press; 2009Google ScholarPubMed.

25. See note 24, Becker 1986; see note 24, Beauchamp, Childress 2009.

26. Schmidtz, D. What we deserve, and how we reciprocate. Journal of Ethics: An International Philosophical Review 2005;9(3–4):435–64CrossRefGoogle Scholar.

27. Gruen, RL, Pearson, SD, Brennan, TA. Physician-citizens—public roles and professional obligations. Journal of the American Medical Association 2004;291(1):94–8CrossRefGoogle ScholarPubMed.

28. Wynia, MK, Clark, CC. Physicians as citizens (letter to the editor). Journal of the American Medical Association 2004;291(17):2075–6 at p. 2075Google Scholar.

29. Jonsen, AR, Jameton, AL. Social and political responsibilities of physicians. The Journal of Medicine and Philosophy 1977;2(4):376–400CrossRefGoogle ScholarPubMed.

30. See note 9, Powers, Faden 2006.

31. Partridge, E, Fouad, M. Community-driven approaches for reducing health disparities in cancer. Journal of the American Medical Association 2010;303(11):1090–1CrossRefGoogle Scholar.

32. Tervalon, M, Murray-Garcia, J. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved 1998;9(2):117–25CrossRefGoogle ScholarPubMed.

33. Chen, DT, Mills, AE, Werhane, PH. Tools for tomorrow’s health care system: A systems-informed mental model, moral imagination, and physicians’ professionalism. Academic Medicine 2008;83(8):723–32CrossRefGoogle ScholarPubMed.

34. Wear, D. Insurgent multiculturalism: Rethinking how and why we teach culture in medical education. Academic Medicine 2003;78(6):549–54CrossRefGoogle ScholarPubMed.

35. Brody, H. The Future of Bioethics. New York: Oxford University Press; 2009, at p. 118Google Scholar.

36. Wear, D, Kuczewski, MG. Perspective: Medical students’ perceptions of the poor: What impact can medical education have? Academic Medicine 2008;83(7):639–45 at p. 642CrossRefGoogle Scholar.

37. See note 36, Wear, Kuczewski 2008:643.

38. Parsi, K, List, J. Preparing medical students for the world: Service learning and global health justice. The Medscape Journal of Medicine 2008;10(11):268Google ScholarPubMed.

39. See note 3, Farmer 2003.

40. See note 38, Parsi, List 2008:268.

41. Kumagai, AK, Lypson, ML. Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic Medicine 2009;84(6):782–7CrossRefGoogle ScholarPubMed.

42. Steinert, Y, Cruess, RL, Cruess, SR, Boudreau, JD, Fuks, A. Faculty development as an instrument of change: A case study on teaching professionalism. Academic Medicine 2007;82(11):1057–64CrossRefGoogle ScholarPubMed.

43. Swick, HM. Viewpoint: Professionalism and humanism beyond the academic health center. Academic Medicine 2007;82(11):1022–8CrossRefGoogle ScholarPubMed.

44. Haidet, P. Where we’re headed: A new wave of scholarship on educating medical professionalism. Journal of General Internal Medicine 2008;23(7):1118–9CrossRefGoogle ScholarPubMed.

45. Betancourt, JR, Green, AR, King, RR, Tan-McGrory, A, Cervantes, M, Renfrew, M. Improving quality and achieving equity: A guide for hospital leaders; available at http://www2.massgeneral.org/disparitiessolutions/resources.html#imqual (last accessed 25 March 2010)Google Scholar.

46. Murray, TJ. Medical education and society. Canadian Medical Association Journal 1995;153(10):1433–6Google ScholarPubMed.