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In a free society where all medical care is privately funded and privately paid for would Objectivist Ethics create a situation under which Free Riders, could exist?

My reasoning follows this path.

If an Objectivist Doctor or hospital/clinic was presented with a patient who had been in a car accident, but had no identification and there was no way to tell if he had medical coverage (insurance) would the ethical course of action not be to treat the patient regardless?

If that is indeed the case would it not follow that some people would game the system in that way?

Also, if the most destitute person could not afford healthcare but became ill and was brought to the hospital, ethically wouldn't it be proper to treat him or her regardless of their ability to pay?

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if the most destitute person could not afford healthcare but became ill and was brought to the hospital, ethically wouldn't it be proper to treat him or her regardless of their ability to pay?

No. Doctors don't have a general responsibility to treat patients. They offer a service. If someone finds that service valuable enough to warrant however much the doctor charges, they enter into a contract with the doctor. The doctor's ethical responsibility only starts once that contract is in place.

If an Objectivist Doctor or hospital/clinic was presented with a patient who had been in a car accident, but had no identification and there was no way to tell if he had medical coverage (insurance) would the ethical course of action not be to treat the patient regardless?

It depends on the situation. If treating the person did not require a great expenditure of resources, it would be in the hospital's best interest to treat, since the likelihood of being payed would be high compared to the cost of treating. However, if it was a very expensive procedure and their was really no way of knowing the economic status of the guy, I don't see how the hospital would have an ethical responsible to treat the person.

A related question: if a hospital did save an unconscious person, would he have a legal responsibility to pay them, if he was able to do so? I don't see how, since he never agreed to enter into a contract with the hospital (though paying would definitely be the moral thing to do.)

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Sounds like it would be in people's interests to donate to a fund or charity that allows for people to be treated at a hospital, especially emergency care, without regard to whether they can pay. That way the hospital would have some money on hand to absorb those costs and not have to worry about such things when someone is bleeding out on a gurney.

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So there is no moral imperative to save a human life?

I don't think you can say the doctor would be obligated, unless he takes upon himself a special committment/responsibility to do so upon entering the medical profession (which raises the question of professional ethics, which may impose obligations on someone not applicable to the public at large). On the other hand, if someone is generally unconcerned with preserving human life I seriously question why they became a doctor.

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So there is no moral imperative to save a human life?

In a true emergency, almost every doctor I know would go ahead and save the life, then worry about payment later. This is especially true in the so-called "Good Samaritan" settings (e.g., a doctor is driving home from work and happens to see someone in a bad accident at the side of the road).

In a setting where there is a fully free market in health care and emergency rooms were no longer obligated by law to evaluate and treat everyone who walked in the door with a serious condition, some might go ahead and treat anyhow (deciding to work out payment later) and others might decline to accept someone who wasn't part of their paid subscriber base.

I also imagine that people would carry wallet ID cards (or necklaces or other forms of ID) that indicated which ER services they've paid for, precisely so that ERs would know who to take and so that ambulances would know where to send patients.

You might also get agreements between groups of ERs, where they would agree to treat patients from each others' networks but for an additional fee -- just like you can use the ATM of a bank where you don't have an account, but might have to pay an extra fee.

The most important thing to realize is that in a fully free market, bright individuals will very likely come up with solutions to these sorts of problems that would be a win-win for all parties. This is especially true in something like emergency medical care, where potential patients realize the enormous value of having access to life-saving services and potential providers realize that there's lots of money to be made in providing such services.

Hence, we don't have to try to work out all the details ahead of time. I'm confident that smarter people than me would figure out robust and viable arrangements to handle these sorts of issues much better than the current mixed private-plus-government system.

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...If the most destitute person could not afford healthcare but became ill and was brought to the hospital, ethically wouldn't it be proper to treat him or her regardless of their ability to pay?

We could answer this question by considering a parallel case with respect to food, namely:

"If the most destitute person could not afford food but were hungry and brought to a restaurant, ethically wouldn't it be proper to feed him or her regardless of their ability to pay?"

At the philosophical level, it would be moral for a person to feed him (or give him any other sort of charity) if it was in accordance with that person's rational values. That might legitimately differ for different people.

At the concrete level, I imagine that those for whom it was rational, they might choose to establish food banks and other methods to feed people who weren't otherwise able to afford food themselves.

In the past, various private organizations often established charity hospitals for the indigent to provide care to those who couldn't afford it themselves. Several doctors I know like working at charity clinics for reasons of rational personal and/or professional satisfaction. In a free society where the burdens of government regulation of medicine were eliminated, many more physicians would have free time/money that they might also choose to donate to charity.

And based on my knowledge of my colleagues, I'm very certain that many more would.

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First of all the question is one of emergencies. As such it is a sidewater compared with the huge river which is ethical principles for a human being to contend with the normal facts of reality.

Second, I would suggest that looking at the attitudes of generosity in the world.....you can't just take today's attitudes and throw them into "an Objectivist world.' If a true Objectivist society were to come into being, things would be very much more harsh...but much more generous as well.

An easy way to understand the transformation? When altruistic efforts are commanded at the point of a gun -- as today -- natural tendencies to be generous wither.

John Donohue

Pasadena, CA

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Sounds like it would be in people's interests to donate to a fund or charity that allows for people to be treated at a hospital, especially emergency care, without regard to whether they can pay.

Why should an Objectivist care? This raises an interesting point about how an Objectivist should evaluate the society in which he lives beyond the formal criterias of respecting rights. Should an Objectivist care about whether people die in emergency rooms or whether large chunks of the population have their opportunities in life reduced due to lack of education and so on? An altruist would say that their concept of "man qua man" requires a sympathy for general human welfare beyond yourself and an ideal human being would therfore regard such societies as sub par, which would then imply action. What is the criterias by which objectivists can say that it is a problem that poor people cannot afford school for thier children? Is there any criterias beyond: If you feel that it's a problem. then it is a problem; if you feel that it doesn't matter to you, then it doens't matter. Does the objectivist "man qua man" ideal give any guideance for what preference is more "qua man"?

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I wish I had it here but if I recall correctly in TVOS Rand makes a statement to the effect that men, recognize the value of other men because they are rational thinking beings. It seems to me then that this indicates that morally men ought to receive special consideration, until such a time as they prove themselves unworthy.

The difference between medical aid and food should be quite clear. A severed artery takes only moments to kill, it takes quite some time to starve to death.

As for emergencies being a sidewater of ethics I really don't understand that concept. The is/ought dichotomy leads to the idea (fact?), yes the fact that ALL actions are either ethical or unethical, moral or immoral. To claim that emergencies are only peripheral to ethics is to claim that men are permitted to cease thinking or at least to think less when in such a situation. There are no issues peripheral to ethics, it is not like a river but like the atmosphere, it surrounds us all the time and is the only thing that keeps us alive as men.

Aside from that I agree that there are a number of solutions to this problem. In addition to the ones Paul has suggested I would add that Doctors would have the option to purchase insurance for procedures undertaken on those who then default on payment or end up unable to pay.

But it is this issue of moral obligation to other men that I wanted to highlight in this thread. I know that word, obligation is going to raise some hackles but I can't think of another that conveys the idea as well, if you can please tell me.

The thing that separates man from animals is the ability to reason. This ability makes each and every man valuable, as a man. If you out of hand reject that intrinsic value by allowing a man to die simply because you can not ascertain his ability to pay a bill then you are lowering the value of men to that of a cockroach or some other insect.

To me this issue comes back to the is/ought dichotomy. In as far as no man is a mortgage on another; men, as men are valuable, otherwise there would be no reason to gather together in societies. Now that any man is of some value indicates that other men ought to place them somewhere in their moral hierarchy(?)*. Where in that hierarchy depends obviously on the situation.

So, in a normal situation in an ER for instance if there is no true emergency such as a mass casualty situation then is it moral that a doctor ignore a dying man for want of payment? Is the idea of payment a higher value than a man's life if the option facing the Doctor is to save a life or sit and do nothing?

Does this make any sense to anyone but me? :)

*I'm unsure if that term conveys the right connotation.

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A related question: if a hospital did save an unconscious person, would he have a legal responsibility to pay them, if he was able to do so? I don't see how, since he never agreed to enter into a contract with the hospital (though paying would definitely be the moral thing to do.)

Um, yes. If you run into someone's *car* you are legally obligated to take responsibility for the damages even though no contract was involved.

I think the ethical/non-ethical nature of a particular doctor's decision to treat/not treat a particular person depends on a lot more than expectation of payment. People are a great potential value and anyone who places value on human life--which is certainly a doctor, otherwise he wouldn't do what he does--will very likely do their best in an emergency even with no expectation of payment.

The only consideration is that the doctor should not *bankrupt* himself treating emergency destitute patients and should *certainly* *seek* to maximize profits given his personal convictions. But money isn't everything and some people don't live their lives strictly on the premise of maximizing their monetary profits in any given circumstance. I certainly don't, and I wouldn't want to.

Free riders are not a *problem*, they are a benevolent side effect of prosperity and basically irrelevant. No one is *forced* to support them and that's all that matters.

As for emergencies being a sidewater of ethics I really don't understand that concept. The is/ought dichotomy leads to the idea (fact?), yes the fact that ALL actions are either ethical or unethical, moral or immoral. To claim that emergencies are only peripheral to ethics is to claim that men are permitted to cease thinking or at least to think less when in such a situation. There are no issues peripheral to ethics, it is not like a river but like the atmosphere, it surrounds us all the time and is the only thing that keeps us alive as men.

A doctor treating a dying patient isn't an emergency of the ethical kind Ayn Rand discussed, because in the hypotheticals she was talking about *all* parties are in immediate danger of death. She was talking about lifeboat scenarios, not all crises that ever happen.

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Is there any criterias beyond: If you feel that it's a problem. then it is a problem; if you feel that it doesn't matter to you, then it doens't matter. Does the objectivist "man qua man" ideal give any guideance for what preference is more "qua man"?

Sure there is: your hierarchy of values. Emotions are great tools if you've programmed your subconscious rationally. Otherwise, you evaluate them consciously based on a number of criteria.

We can't enumerate the criteria right here, though, because it depends on the person and the situation. It's contextual, not irrational.

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A doctor treating a dying patient isn't an emergency of the ethical kind Ayn Rand discussed, because in the hypotheticals she was talking about *all* parties are in immediate danger of death. She was talking about lifeboat scenarios, not all crises that ever happen.

I wasn't referring to emergencies per se, but to the fact that every decision is either ethical or unethical, there is no "kinda" ethical... no sidewater of ethics as John Donohue implied.

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Zip, Rand meant that emergency situations are not the basis on which you should build ethical systems; they are complicated and often have no "good" choice. So to start with that as a reasoning point for any ethical question is like trying to start your studies of physics by figuring out how to calculate the orbit of the moon. First you must have a strong grasp of ethical principles, and then, as with the orbits of any heavenly body, each situation is unique and complicated.

Anyway, I think this qualifies as a "complicated" problem. Does the doctor have bills to pay? Will he be responsible for the bills of the patient if the patient defaults? Is this a repeat bum who constantly puts him/herself in danger? etc., etc., etc., ad infinitum. A thousand different small variables will change the answer one way or another. Which illustrates a simple point: its not required of any human to sacrifice his life, or any portion of it, to another if they do not think it is in their best interests.

So no, no man has an 'obligation' to become destitute, or starve, or lose his or her practice, or any other negative effect, for another human. I agree that men of good morals have a general benevolence towards other men, but that does not mean that there is any obligation between them. Such men will be more inclined to help each other, if the costs are not too great, but no men can claim others must help him or be immoral.

To give a simple example, I once helped to rescue a man from a burning car. It was late at night, and I was wide awake. I passed a wreck on the side of the highway, and noticed one of the cars was on fire, and still had a person in it. Other cars were already pulling or pulled over - so I did the same and hopped out. I helped get the door open while some others got the guy out and carried him a safe distance from the car.

My considerations:

1) Cost to myself - a little bit of time. Negligible.

2) Danger to myself - unlike in the movies, I don't believe cars are very likely to explode when on fire. Negligible, again.

3) Payoff - satisfaction of playing a small role in quite possibly saving a human life. High.

Now, some other things. I don't know who caused the wreck; if it was the individual's fault and I knew it, I may have kept on speeding. Given the circumstances, however, and the low cost of the act, I thought it best to assume the best circumstances; ie, that some third driver or some legitimate problem related to driving late at night caused the wreck, and not negligence on the part of any of the people involved.

I beat it before the cops and paramedics arrived and never pursued information about the wreck. So I can't tell you what actually happened or if the guy even survived - he didn't look too beat up but he was unconscious. I just did what I thought was best under the circumstances.

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That's exactly what I was trying to say Santiago. The situation still dictates whether the service is provided and indeed whether the service is moral or immoral.

I knew that this would be the case, but those who vivisect Objectivism often point to the selfish nature of it and say that we would let the poor die in droves and only the rich would be worthy of respect in an O'ist society.

I actually received a PM on this when I posted this topic from someone saying that I was going to come up against the cold heartless reality of Objectivism in this topic and that I should watch out, lest I become disgruntled and end up a liberal like him.

:)

:D

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The poor won't die in droves under Objectivism - but not because of the benevolence of men saving others.

The view of human beings as incompetent animals, constantly getting themselves into trouble - and the task of life, of constantly getting you or someone else out of that trouble - is a worldview directly opposed to Objectivism. The poor WILL NOT die in droves under Objectivism, because every human being is capable of sustaining themselves in some manner.

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As for emergencies being a sidewater of ethics I really don't understand that concept. The is/ought dichotomy leads to the idea (fact?), yes the fact that ALL actions are either ethical or unethical, moral or immoral. To claim that emergencies are only peripheral to ethics is to claim that men are permitted to cease thinking or at least to think less when in such a situation.

Zip, from my understanding, that is exactly the nature of emergencies. Most emergency situations are defined by:

1. Someone's life, possibly your life, possibly several lives are at stake.

2. There is a significantly short time to act.

3. Emotions are usually running high.

The combination of these three mean exactly that men will cease thinking or think less in these situations.

People are not robots. Our cognition is influenced by our emotions and the situation around us. It is possible for a completely ethical person to make the wrong decision in an emergency. This should not be held to the same standard of moral judgement as, say, a business decision made from the comfort of an office chair.

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The poor won't die in droves under Objectivism - but not because of the benevolence of men saving others.

The view of human beings as incompetent animals, constantly getting themselves into trouble - and the task of life, of constantly getting you or someone else out of that trouble - is a worldview directly opposed to Objectivism. The poor WILL NOT die in droves under Objectivism, because every human being is capable of sustaining themselves in some manner.

Obviously I meant under such "emergency" situations...

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So there is no moral imperative to save a human life?

No, not without a particular context.

Let me expound on that a bit. For one who values his life, there is a moral imperative to save HIS life. To the extent that saving another person's life furthers that goal, then one should save another person's life. But again, that calls for the specifics of the context.

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Um, yes. If you run into someone's *car* you are legally obligated to take responsibility for the damages even though no contract was involved.
I'm afraid that's not a valid basis. If I paint your house without your permission and without evidence that you agreed to pay me some price for doing so, I can't then collect because I acted to your benefit. When you violate a person's rights, you can be held responsible for that violation thus be obliged to compesate them -- you are generaly required to not violate another person's rights -- but being unconscious is not a violation of someone's rights, so it doesn't create an obligation to compensate. On the contrary, a very strict view of rights and obligation would say that the hospital does not have the right to treat a patient who does not give consent and would hold the hospital liable for any damages caused by their un-permitted action. Although I think it's stupid for a person whose life was just saved to sue a hospital because the guy realized "Woo-hoo! I didn't give permission, I get to collect a million bucks".
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So there is no moral imperative to save a human life?

There are no imperatives.

Sounds like it would be in people's interests to donate to a fund or charity that allows for people to be treated at a hospital, especially emergency care, without regard to whether they can pay. That way the hospital would have some money on hand to absorb those costs and not have to worry about such things when someone is bleeding out on a gurney.

Exactly. In an Objectivist society people and institutions would be better able to afford generosity, and better motivated to be generous when they knew they had no part in alleviating the situation indirectly through their taxes.

The particular free riders that are problematic would be recognized on sight and refused service.

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Let me first say I know that imperative was the wrong word to use in the context of morals. However, the existence of a moral hierarchy (as individual and situational as that hierarchy may be) by definition leads to sequential priorities.

These priorities are as I said widely situational but all things being equal the moral action "save a human life" ought to be placed before the moral action "eat my lunch".

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Let me first say I know that imperative was the wrong word to use in the context of morals. However, the existence of a moral hierarchy (as individual and situational as that hierarchy may be) by definition leads to sequential priorities.

These priorities are as I said widely situational but all things being equal the moral action "save a human life" ought to be placed before the moral action "eat my lunch".

I dunno, what if I'm starving?

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I dunno, what if I'm starving?

:dough:

Let me first say I know that imperative was the wrong word to use in the context of morals. However, the existence of a moral hierarchy (as individual and situational as that hierarchy may be) by definition leads to sequential priorities.

These priorities are as I said widely situational but all things being equal the moral action "save a human life" ought to be placed before the moral action "eat my lunch".

:dough:

Come on Santiago... :D

Edited by Zip
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