How in the world did we ever survive in this evil evil country without EMTALA? Without forcing doctors and EMS providers to haul an able bodied 30 yr old with a 3 day rash to the ER while the 55 yr old diabetic sits at home having his heart attack waiting on that ambulance to get to him. Heaven forbid we tell the rash person that there are more important calls than her rash. BTW in this case the wife of the MI victim raised caine about the 15 minute wait her husband had to endure while the ambulance dropped the rash off and went back for him. I should have taken her to the room where the itchy scaly person sat texting on her cell phone waiting on her free pregnancy test (the real reason she was there) and let her know the real reason her husband sat dying for 15 minutes. Thats what we need in this country…social justice. Then none of this would be an issue. I’d like to see the real pain patients get a hold of the drug seekers. I’d buy that on pay per view.

First, no one forces you to become one. Since this is true, positive rights are not in play. It’s just like being a soldier who volunteers–you accept certain duties as a result, often these are duties conflict with your other rights.

Second, medical education is subsidized by the taxpayers. Unless you pay for medical education at a private medical school, you already are obligated to perform services for the good of society because you have received a benefit from society.

This is a very common misconception, even among physicians. There is absolutely nothing in the HO that says that a physician has a moral obligation to take care of anyone. This is logical since that would be a positive right. Every positive right invariably results in the erosion of the rights of another. That is why the the United States was founded on negative rights. This is the reason for our preeminence in the world.

I would like to hear from the sultan regarding the Oath. What line in the Oath actually states that a person has a right to your services? What line even states you have a moral obligation to provide your services?

vincent

The point is that a physician is a private citizen with the same rights to life, liberty and property under the US Constitution as any other citizen. There is a huge and fundemental difference between SOCIETY deciding to provide emergent or even non-emergent services and society, via government fiat, requiring a subset of private citizens ( ie physicians) to care for these people without just compensation. The latter is undeniably enslavement and involuntary servitude which is expressly prohibited in the US Constitution.

Vincent

Truth is, I have not yet met any EPs who would even consider not treating a patient if they needed help but were unfunded. Hell, I don’t even have a clue as to my patients’ insurance status until I have to find an admitting doc and have to call the correct physician based on their coverage (or lack thereof). I am not naive enough to believe a for-profit hospital system would ever allow itself to tip the budget into the red becasue of my or my colleague’s charitable practices but I work on an RVU system where I only make money on what the group collects. EMTALA may state that I have to screen the patient and provide a certain level of care, if warranted. But Hippocrates told me I had an even larger, nobler obligation long before I had even heard of EMTALA. We as a nation have decreed-through EMTALA-that it is the responsibility of a hospital to offer a minimum level of care to our citizens when they are at their neediest, regardless of ability to pay (assuming the use of ERs is limited to only true emergencies or what the layperson has determined to be a true or potentially true emergency; a shaky premise.) This is actually one of several examples of what makes ours a great society in that we as EPs accept this responsibility as our own, doing our best to give our neediest the best care possible using all that is available to us. Healthcare-as has been defined by the single-payer crowd- is not a right at all, much like it is not my right to deliver it. It is my privilege to practice medicine and it is a privilege to benefit from the labors of others, even if you really, really, really want or need what they have to give. The best example I can think of off the cuff is the tremendous expenses incurred at the end of life. Day after day, I respond to codes in the ICU that nearly always involve an elderly patient who-by all reasonable standards-had very little quality of life for previous days or longer while the hospital honored the family’s wishes to do all that was medically possible, utilizing a bed that could have been used for Evan’s DKA kid. (Now this part may sound uncomfortable but I am speaking in terms of The Big Picture.) I go to their bedside and push expensive drugs, utilizing expensive critical care nurses and RTs, allowing sick patients in the ER to build up and slip further into their respective pathologies, all the while knowing that-for so many of these patients I encounter-the return of a heartbeat may be the last thing they would have wanted, given the choice but, since the family’s wishes were made clear we do all that we can anyway. I am a tremendous proponent of elderly rights but I also believe in the humane treatment of our sick. Who exactly determines what is the scope of mandated care? The government? The patient’s family?

By saying “healthcare is a right”, exactly how much healthcare are you referring to? Lifesaving treatment that results in a worse quality of life than you would otherwise want to live with? Are we going to mandate advanced directives? For the kid in DKA, what if he has a bad outcome and his kidneys are shot? Do we mandate organ donation? What if your local ophthamologist is not a retina specialist and you have a detachment that requires urgent attention? Do we mandate the appropriate specialist fly out to treat you, neglecting their other patients and-in the EMTALA model-not getting compensated for their expertise but still assuming the significant liability?

The simplest rebuttal to whether health care is right or not is already well documented. Entire counties in the US do not have EMS systems or hospitals to serve its citizens, for reasons financial and logistical. This leaves thousands of Americans without access to healthcare in a timely or any other fashion. How do they exercise their “right” to health care, emergency or otherwise? No, the availabilty of healthcare services is determined by the responsibilities we have ascribed to those who decide they will provide them. I think we need to better define what constitutes “healthcare” as a nation, with reasonable expectations to what our society can afford and what we as physicians can provide.

As for EMTALA, I have no problem with my country telling me that it is my responsibility to help its citizens in their time of need. It would just be nice if they didn’t hold a gun to my head as they said it. The hungry man doesn’t go into a restaurant, take food from the oven, eat it, then demand the cook’s wallet before letting his hungry friends in to do the same. Isn’t food even more basic than healthcare?

Here is where I think you are incorrect: the notion of mandate. I do not think that a society that does not mandate the care of a child in a diabetic coma is necessarily worse than one that does.

We have now a society that sloppily makes those kinds of mandates, with little regard for how or who will have to provide those mandated services. Our ability to honor any such mandate is contingent on means that are assumed always available on demand when in fact they should not be assumed to be so.
And where these means are available, those imposing the mandates have not in turn assumed the responsibility for fair compensation to those compelled to provide those goods and services. It hardly matters whether the purpose is a lifesaving one or a complete waste, as long as full and timely compensation is not provided, and those in the position of providing have not at least some right of refusal, the injustice to the providers is the same. As things stand, with EMTALA, government has shirked its duty and rationalized its acts on the thinnest of utility arguments. And they have completely ignored the issue of justice.

Preferring a society that chooses to provide medical care to those in dire need while recognizing that those called on to provide that care in a timely fashion deserve fair (not merely what is available from meager budgets, or chance) compensation for providing that care does not require that I concede that health care is anybody’s right. It simply never is. Providing emergency care is the mark of a just and compassionate society–and a necessarily wealthy and advanced society– in our contemporary understanding. But that does not make an absolute right, nor is it a carte blanche to seize the labors and property of others to further that end, without compensation. Unfortunately with EMTALA, that is exactly what we have: an entitlement to take without compensation, which itself is unjust. In my view, Congress had no right to pass such a law without providing fair and prompt compensation to those who have to provide that care, the hospitals and their affiliated staff. Accepting the status quo is endorsing injustice merely because it satisfies our notion that a greater benefit results to someone else. We do it because it is convenient and because we get away with it. That is not acceptable.

I do not see any disconnect between a moral imperative to render assistance and the idea that health care is not a right. It is a notion as old as our country and was the driving force behind the establishment of the first hospitals in the United States.