“The more we do to you, the less you seem to believe we are doing it.”

                                                                                                 -Joseph Mengale

 Liberal economists and ethicists, clandestine in their efforts to influence the medical profession and the delivery of health care to all Americans, croon about the concept of distributive justice. Unfortunately, many in the heath care industry, including doctors and their representative medical societies, are singing along unmindful of where distributive justice can lead them. 

Among the more visible proponents of distributive justice in medicine is bioethicist Ezekiel Emanuel, MD, brother of the current White House Chief of staff Rahm Emanuel. In fact Dr. Emmanuel is currently serving as an advisor to the Obama administration on health care reform. He has cited the modern day father of distributive justice, philosopher John Rawls ( A Theory of Justice, 1972) in his writings. Rawls believed that resources should be available to all equally but, seemingly in contradistinction to that statement, that they be given to the greatest benefit of the least advantaged members of society. This would certainly be problematic in America where there is no caste system and people commonly go from less advantaged stations in life to more improved ones. Therefore, what criteria will be used to determine advantages and more importantly who will be making these decisions? In his book “The Ends of Human Life”, Dr. Emanuel evaluates the justice of the distribution of health services to the populace. In it he queries- “What considerations should determine the availability of services and patient selection for medical services?” The use of the word selection is disquieting. He goes on to state-“The quantity of social resources (read your money) devoted to medicine will influence the range of services that can be provided and how restrictive patient selection criteria must be.” Given the political leanings of Rawls and Emmanuel one can conjure up what selection portends. Aristotle believed in the concept of distributive justice in a different way. He too realized that allocation of scarce resources needed to be justly distributed but believed that merit not station be its constituent.

 The concept of distributive justice in medicine places the individual patient at greatest risk. Allowing it to be implemented would be to dispense with the Hippocratic Oath, a concept applauded by Dr. Emmanuel, and would break a physicians promise to do no harm. It will take us to a construct of medical minimalism where the least for the individual will be the best for society and the state. In such a system individual worth, and moreover, the worth of human life will diminish and the power of government will expand. Author Harold O. J. Brown writes about the threat to the individual patient in his book “The Sensate Culture”. He writes-“They become ciphers in the calculus of societal utility, like the animals in a veterinarians care, treated and healed when it is possible and economically feasible but painlessly disposed of when it is not.” The proxy for this in America is former Governor of Colorado and physician assisted suicide advocate Richard Lamm. A once powerful politician, he once stated that the elderly and terminally ill had “a duty to die and get out of the way”. Hilariously, in a New York Times article after that statement, he made an imbecilic attempt at an apology stating- “I was essentially raising a general statement about the human condition, not beating up on the elderly.” Once a Democrat, Mr. Lamm is now thankfully a member of the Reform Party and has therefore been politically neutered. Regrettably, there are those of his ilk in the seats of power today.

Almost sixty years ago in the New England Journal of Medicine an article by Leo Alexander M.D entitled “Medical Science Under Dictatorship” castigated the physicians and scientist who assisted the Nazis in purging the sick and frail in their pogrom against their own people and the people of the world. He noted the omnipresent “preparatory propaganda” that was “directed against the traditional compassionate nineteenth century attitudes toward the chronically ill”. And, “By 1936 extermination of the physically or socially unfit was so openly accepted that its practice was mentioned incidentally in an official German medical journal.” After Alexander poignantly cataloged Nazis atrocities perpetrated by doctors he left us with this: “Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of the physicians.”

Joseph Mengale was the most brutal Nazi physician at Auschwitz.