During medical school, future physicians learn of the four pillars of medicine, the ethical foundation upon which we should strive to build our work in the field. The first three, beneficence (provide good care), nonmaleficence (do no harm), and respect for autonomy (of both patient and physician) are oft-cited in the medical literature and emphasized in our current healthcare system. The fourth pillar, justice, is sometimes forgotten. Webster‘s defines justice as “the quality of being just, impartial, or fair”. In simple terms, then, all physicians have been given the ethical obligation to treat all patients in a fair and impartial way. On a societal level, the fourth pillar of medicine provides the foundation for us to say that all persons have the right to quality health care. We are not living up to to this obligation. Very real disparities still exist in our health care system.
This week my twitter feed and facebook page filled with analyses and opinions about the Supreme Court’s decision to uphold the Patient Protection and Affordable Care Act. Amidst all of the chatter, came an important voice. An inspired, brilliant reminder of the need for justice in our health care system. A reminder of how stark the disparities still are, and how much the social determinants of health impact lives. A call to action for those of us with a voice in health care, to use it, and well.
I hope you will read Dr. Donald Berwick’s moving speech, “To Isaiah“, recently given at Harvard Medical School’s Class Day, in its entirety. In part, he says,
“It is time to recover and celebrate a moral vocabulary in our nation—one that speaks without apology or hesitation of the right to health care—the human right—and, without apology or hesitation, of the absolute unacceptability of the vestiges of racism, the violence of poverty, and blindness to the needs of the least powerful among us.”
May we work to “cure the killer injustice.”