Transcript professionalism, technology, and business.

Ronald F. White, Ph.D.
Professor of Philosophy
College of Mount St. Joseph
• The growth in the number of health care
experts and technology are explicable in
terms of complex adaptive systems theory.
• Biological evolution and cultural evolution
play a role in both the reliance upon
experts and technology.
•
•
Medicine addresses human values.
Therapy: Human beings get sick. (Therapy)
–
Physical disease
•
•
•
•
•
Infectious disease
Genetic Disease
Injury
Mental disease
Enhancement: Human Beings want to improve the quality and quantity of life.
–
Physical enhancement
•
•
•
•
Cosmetic surgery
Breast enlargement/reduction
Hair growth/removal
Sexual
–
–
•
Mental Enhancement (emotional and intellectual)
–
–
–
Menopause
Viagra
Counselors
Drug therapy
» Attention deficit disorder
Quantity of Life: Human beings prefer to live longer lives (if quality).
•
Life extending biotechnology
• What is an expert?
• What are the various classes of “health care experts or
professionals”?
–
–
–
–
–
–
–
Physicians
Dentists
Pharmacists
Nurses
Non-physician practitioners
Allied health professionals
Health services administrators
• Experts and Complex Systems
– Prediction and control of complex systems
• Limits of Science
• Exercise of Power in Social Systems
• Unanticipated consequences
•
•
Why is health care characterized by a proliferation of “experts?”
Evolutionary Foundation
–
–
–
•
Human beings and control of destiny
–
–
•
Variation
Replication
Selection
Biological determinants (genes)
Cultural Determinants (beliefs)
Biological Evolutionary Forces
–
–
Pain and Pleasure
Human Predisposition toward hierarchical social relationships.
•
•
•
–
Morality
•
•
•
Feelings of sympathy
reciprocation
Cultural Forces
–
Beliefs
–
From Religious experts to Scientific Experts
•
•
•
•
–
Teaching and Learning
Materialism and Reductionism
Marriage counselors
Child Psychologists
Role of Institutions
•
•
•
Leaders and followers
Social Status of Leaders
Males and Females
Churches
Educational
Economic Forces (buyers and sellers)
–
–
–
Innovation
Competition between experts
Monopoly by experts
•
•
Natural monopolies
Artificial monopolies
•
The Social Construction of Disease
– Control of Human Beings and their Environment.
•
Malleability of the Concept of Disease
– From Natural Processes to Disease (childbirth)
– From Vice to Disease (alcoholism)
• Marriage counselors
– Sex as a skill
• Child psychologists
• Self-help experts (Norman Vincent Peale)
•
Moral Values
–
–
–
–
•
Beneficence-alleviation of pain and suffering
Utility-social good
Liberty
Justice
Information (Beliefs)
– Public and private education
– Mass Media
•
Technology
• Forms of Medical Technology
– Information Technology
– Drugs and Devices
• Technology and Culture
– Automobiles
– Telephones
– Computers
• Biomedical Technologies
–
–
–
–
Beginning of life
End of Life
Life sustaining
Life enhancing
• Evolutionary
– Increased Variation
– Selection (competition)
– Direction
• Progressive• Regressive• Equilibrium
• Role of Government
– Experts
– Central Planning
• Role of Corporations (sellers)
– From Judeo-Christian and Hippocratic Medicine to Big Business
• Role of Individuals (buyers)