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April 7, 2009
Society's agent
This issue of JAMA, April 8 (301, 14 p. 1482-4) contains a commentary by Kirch and Vernon on Social Justice in medicine. They contend that the first three pillars of the foundation of medical ethics (beneficence, non maleficence and respect for autonomy receive plenty of attention, but that justice is underemphasized. In discussing autonomy, they quote an article by Kluge, a Canadian ethicist, that the physician "is society's agent and as such has delegated authority in matters of health care delivery."
In light of the constitutional prohibition on titles of nobility, Herb Titus has argued persuasively against state licensure. This concept of being society's agent is flatly unconstitutional.
Further, it is contrary to reason. What is society? If one means the civil government, than say so. But the civil government is force, not reason. If one means the local community, that is more reasonable, but contrary to the force of the state.
More importantly, this view ignores the fact that Jesus reigns in Heaven and on earth. I am obligated to obey him, to be his agent. That, of course, does not preclude a temporal authority as well. But that temporal authority must also be obeying Jesus. So it is not the desire of society, or the patient, or the doctor, that is the main consideration, but of Jesus.
It is no wonder that the ethicists and policy makers find confusion amongst the options of models. Only the model of mutual servanthood can solve these dilemmas. I am a servant of Jesus and of his creation. I advise and treat fellow servants (even those that rebelliously reject or deny the Master). There is no autonomy, there is no abstract justice, there is no way to determine good or harm apart from his standard.
Posted by Robert Maddox at 9:39 PM | Comments (0)