[Congressional Record Volume 146, Number 94 (Wednesday, July 19, 2000)]
[Extensions of Remarks]
[Pages E1269-E1270]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       AN ETHICAL QUESTION FOR HOSPITALS AND MEDICAL CORPORATIONS

                                 ______
                                 

                        HON. DENNIS J. KUCINICH

                                of ohio

                    in the house of representatives

                         Tuesday, July 18, 2000

  Mr. KUCINICH. Mr. Speaker, today I speak about the question: should 
hospitals and medical corporations be held to a higher standard of 
ethics and social responsibility than other corporations? To answer 
this important question I refer to the Constitution of the United 
States. In the Preamble we read that the basis of this great country 
rests in part in the words ``promote the general Welfare.'' This is the 
essence of what we are about and what should be considered in all moral 
and ethical arguments concerning public policy. I will use this premise 
in my answer to the question: Should hospitals and medical corporations 
be held to a higher standard of ethics and social responsibility than 
other corporations?
  From the earliest written history the role of the ``healer''--or 
medical doctor in our modern terms had a special role. The Code of 
Hammurabi, which was practiced in Sumeria and Babylonia, clearly 
stipulated the physical penalties to be inflicted on the ``healer'' in 
cases of failed surgery. For example the Code states, ``If a doctor 
operates on the eye of a gentleman, who loses his eye as a consequence, 
the hands [of the doctor] shall be cut off.'' This is a clear statement 
of medical responsibility and its consequences.
  This is indicative of the value of human life and special 
responsibility of physicians. The Hippocratic Oath, taken by medical 
doctors at the end of their medical studies, states existence of a 
special relationship between the patient and the physician. In previous 
times, the physician was held in great respect, not because of the 
economic status, but because of the respect for the learned arts that 
the physician was trained in. This is the basis of the unique 
relationship between the patient and the ``healer.''
  I am greatly concerned that in recent times this special relationship 
between the patient and the physician has radically changed. For 
example, I cite the concept of a distributive ethic which is widely 
promoted and used by health maintenance organizations. The distributive 
ethic may be stated as the principle to provide the greatest good for 
the greatest number of patients within the allotted budget. The problem 
is that it is not possible to simultaneously provide optimal care for 
an individual patient and for the entire group of patients at the same 
time. This is an example of the change in the relationship between the 
patient and the physician that has occurred with the development of our 
new business models to deliver health care; i.e. HM0's.
  An example of the business practices of HMO's that are in conflict 
with the former respectful, sacred relationship between the patient and 
the healer is the use of a fixed sum of money for the annual care of a 
group of patients. If the physician can reduce the referrals

[[Page E1270]]

to specialists, which would rapidly deplete the fund allocated by the 
HMO for the patient pool, then the physicians can take the remaining 
funds for themselves. How can anyone consider that this current 
business practice is in the interest of the patient?
  Another area of current medical business practice is the financial 
involvement of the physician in the pharmaceutical industry. How can a 
clinical study be considered unbiased when the principle investigator 
is a share holder in the corporation that is financing the clinical 
study?
  Can a corporation that owns a series of clinics and hospitals in a 
neighborhood decide to close one or more of them on the grounds that 
this will decrease competition? Is a hospital to be viewed in the same 
ethical way as any other corporation? As a extension of the patient-
physician relationship and it special and sacred relationship that has 
existed from ancient time, it follows that the corporation that owns a 
hospital has a moral obligation to promote the general welfare.
  In summary, current business models and practices are not consistent 
with the ideal ``to promote the general Welfare.'' Hospitals and HMO's 
have a unique role in our society, and with that unique role come 
unique responsibility. I believe that the only conclusion that 
reasonable people can hold is that hospitals and medical corporations 
must be held to a higher standard of ethics and social responsibility 
than other corporations.

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