In the contrasting philosophies of the ADIO viewpoint and the outside-in viewpoint regarding health, the question arises of who the health care provider is responsible to. Prior to the advent of third-party pay, it was not an issue. The health care provider was responsible to the individual who paid him/her, the patient. The individual entered into a contract with the provider and the two of them agreed upon the terms. For all intents and purposes the patient employed the doctor. With the advent of third-party pay a new member entered, the insurance company. It was still an agreement of sorts, just a little different because it was a three-party agreement. If the consumer did not like or was not satisfied with the agreement he/she could change insurance companies or get out of the agreement altogether and not utilize insurance. While this system had its merits, it also had its drawbacks. The greatest drawback was that it slowly prepared us for the eventual government control system. The issue that faces us is that there is no longer an agreement between those participating in the contract. There is no longer a contract. This is a foreign idea in a society that understood personal responsibility, private enterprise, and personal freedom. It is not foreign to societies that do not adhere to those ideas or who utilize state-controlled systems.
Plato addressed the issue in his book Republic. There was no contract between physician and patient. The physician was not employed by the patient. He was a servant of society and it was understood that the care he gave to an individual was for the benefit of society not the individual. “Society” (read, the government) paid the bill. Those who no longer contributed to society, the old or those who may never contribute, the infirm or disabled, were not treated. A person was not special, not an individual. Each was a member and part of society.
Hippocrates was a contemporary of Plato. He recognized the importance of the individual. Hence, the development of the Hippocratic Corpus which, in essence, expresses that a physician should, “first do no harm.” In Plato’s philosophy there was no good or bad, no issue of right or wrong when it came to how medicine was practiced. The physician decided whether his care was good for society. The patient or his desires were not at issue. In this world viewpoint there was no individual, just society. There was no individual worth, no standard, force, or principle above society. The government had control and made the decisions. Once government is placed above the individual, the respect for the individual, as an expression of Someone greater than the government, ceases to exist. Government is no longer the servant of people but the master, hopefully a benevolent master.
Sadly, we are reaching that point in this country. The doctor will be an employee of the state. He will be required by the state to follow its dictates. Will embracing our new health care system create the problems that many are concerned about? I believe that the concerns are well-founded, if for no other reason than the world and life viewpoint that is represented by this government-controlled system lends itself to the kind of abuses that many people fear. I can see how some could accept the idea of death panels. Abortion is already accepted by our government, even though most people reject the idea. The next step is proposed by Peter Singer, an outside-in thinker who is chairman of Bioethics at Princeton University. In his book Rethinking Life and Death, he suggests that babies should not even be considered human until five weeks after birth and it has been determined that the child will not be a burden to society.
This is not a new idea. It has been embraced by many societies, all of whom embraced or had leaders that embraced an outside-in world and life viewpoint. Many of these societies were of modern times and very advanced, as opposed to being a primitive society. Many totalitarian countries easily embraced it. Adolph Hitler and his National Socialist Party sought to wipe out an entire race of people he felt were undesirable and a drag on society. Communist countries have killed or allowed millions of people to die.
The bottom line concerns world and life viewpoint. The outside-in viewpoint is one that is self-centered; a human viewpoint, considering the self as the center of the universe. There is nothing above or greater than man’s desires. Sometimes it masquerades as being altruistic. Hitler really believed he was doing something wonderful and the world would be a better place if the plans of the Third Reich were carried out. Socialism believes it is doing the greater good for the greater number. So Chairman Mao could kill off 40 million people to make life better for 400 million.
The ADIO viewpoint is that there is something above the selfish, educated ideas of the collective society. There is a principle or law and there is a Law Giver. Each person has individual worth. First, because each was created by God in His image. Second, because each was given a soul and, in that sense, equal to everyone else, “endowed with certain inalienable rights.” Third, because each has an inborn intelligence, a principle of biological life that needs to and deserves to be expressed. Any government that interferes with that full expression, whether it is for the greatest good for the greatest number or because some educated brain has determined that everyone needs or does not need some drug, chemical, substance or procedure, is JUST PLAIN WRONG. That is the conflict that rages within our health care system and it is one that we as chiropractors should take a stand on. That stand should be based upon principle rather than what we think is best for our selfish, professional desires. V25n4