Taking the Train to a World of Strangers: Health Care Marketing and Ethics

Abstract

The marketing of health care services raises the Prospect that an ethic of will govern relations between providers and patient& A fiduciary model that emphasizes honesty and public accountability, as well as the patient's good and avoiding unnecessary services, keep marketing consistent with the ethical tradition of medicine. The natural limit to any person's moral universe, for Tolstoy, is the distance he or she walk, or at most ride. By taking the train, a moral agent leaves the sphere of truly moral actions for a world of strangers, toward whom he or she has few real obligations and with whom dealings be only casual or commercial.' For hospitals, physicians, and patients, the times. are more than a'changing. The American health care system is undergoing an economic revolution.2 Fewer patients, fewer occupied acute care beds, and fewer reimbursement dollars have converged to push health care providers from peaceful coexistence into outright competition. Hospitals and physicians, to remain competitive, are now marketing their services like commercial sellers. We believe it is time to evaluate health care marketing from an ethical perspective. Health care marketing raises the fundamental questions of whether caring for the sick is actually just another commercial endeavor to be sold effectively and profitably to the public and whether the conduct of health care providers should be governed by the same basic ethical values that apply to any other business. Put differently, should health care providers take the train to a world where providers and patients are whose obligations to each other are few and whose dealings can be only casual or commercial? A Moral Exemption for Business? All human activity is subject to ethical evaluation. Any human act violate someone's rights, show disrespect for persons, or have harmful consequences for the agent or others. At a minimum, an of strangers applies to all equally with attendant basic obligations that are limited, anonymous, and chiefly negative: namely, not to act offensively, violently, or deceitfully. Persons conducting business are subject to the same negative moral obligations as everyone else.4 PoSitive ethical obligations, such as doing good by donating money to charity or maximizing shareholders'interests, may govern business activity, but their applicability is controversial. It is unarguable, however, that all persons, including those conducting business, are ethically obligated to refrain from fraud, coercion, violence, or otherwise doing harm to others. Assuming that basic moral obligations are met, it is not unethical for a business to conduct arm'slength transactions with under the assumption that both parties are (more or less) independent, equally positioned, and admittedly self-interested individuals who decide for themselves the value of the commercial transactions they make. Nor is it intrinsically unethical for a business to sell a product by intentionally associating it with a desirable extrinsic feature: for example, linking possession of a certain object (a sports car) with romantic or sexual success. (Such promotion is perhaps open to question as to whether it intentionally deceives consumers.) There is no special relationship between a business and its customers that generally obligates the former to comply with greater or higher ethical duties than those imposed by the common ethics of strangers. Health Care Providers, Patients, and Ethics We will use the term provider to include both individual persons and corporate institutions that provide health care services to patients. The basic ethical obligations of all providers are similar because all are engaged in the special activity of caring for patients. Furthermore, the status of health care institutions as for-profit or not-for-profit entities does not affect the ethical obligations imposed upon them insofar as they all hold themselves out as caring for patients. …