 |
 |
|
Health Care Ethics USA Should Hospitals be Patriotic? When Henry Clay died in 1852, America fell gloomy mourning one of its greatest orators and statesmen. In Springfield, Illinois, Abraham Lincoln delivered the eulogy and quoted the following from one of Clay’s political opponents. Who can realize that freedom’s champion -- the champion of the civilized world, and of all tongues and kindreds of people, has indeed fallen!… His career has been national -- his fame has filled the earth -- his memory will endure to ‘the last syllable of recorded time.’1 Alas, Americans are not known for their long memories. It is a mere one hundred and fifty years after Clay’s death and syllables are zooming across the globe at record speed. But hardly anyone remembers Henry Clay. According to a recent survey of America’s top universities,2 Americans don’t remember James Madison either (less than 23% can identify him as the "father of the Constitution") and most recall almost nothing about the careers of Abraham Lincoln and George Washington. As memories fade, so do collective ideals, patriotism, and the sense of our country as a genuine community. But our memories were activated on September 11, 2001. And so far they remain in service. In this essay, I discuss the links between memory, community, and patriotism, and inquire about patriotic duties of hospitals arising in the War on Terrorism. Despite pitfalls and limitations, I hold that hospitals ought to be patriotic. Principles America’s great idealist philosopher Josiah Royce describes community in the following terms: Now when many contemporary and distinct individual selves so interpret, each his own personal life, that each says of an individual past or of a determinate future event or deed: "That belongs to my life"; "That occurred, or will occur, to me," then these many selves may be defined as hereby constituting… a community. They may be said to constitute a community with reference to that particular past or future event…3 Because of our collective emotional and intellectual involvement with the 9/11 tragedies, Royce would say that the United States has once again become a "community of memory." Whether we hail from New York, Saint Louis, or Walla Walla, each of us has been affected by these events. They belong to our lives. One result is that patriotism is again a part of our national landscape. Patriotism is a characteristic of persons and communities who regard their nation as a moral community worthy of service and sacrifice. Patriots honor and cultivate national memories, and they are loyal to national ideals. This is not to say that the patriot will be un-critical, or that she will not strive at times to revise, re-interpret or resuscitate the collective morality. To the contrary, constructive criticism is a duty of patriots and the only way to keep national ideals vital. Patriotism devoid of the critical spirit is a form of what Royce called "degenerate loyalty," where the ideal is taken as a static dogma championed by a moral elite. Patriotism is often regarded with suspicion because of fear that it will devolve to one of its degenerate forms -- jingoism. Like any degenerate loyalty, jingoism results from an uncritical, chauvinistic assertion of the primary community (the polis in this case), over and against other communities and their interests. Degenerate loyalties derive from an inability to see humanity as sharing a common, or at least overlapping, moral destiny. Discussion Assuming that hospital mission statements can be taken at face value, the typical American hospital can be regarded as a kind of moral community, defined by its members’ commitments to determinate future events such as the amelioration of patients’ suffering and the prevention of untimely deaths. As such, patriotism is a possible predicate of hospitals. Insofar as hospitals exhibit loyalty to the polis, they are patriotic. But should they be? In the aftermath of the 9/11 attacks, hospitals are being asked to shoulder an increasing burden in preparations for terrorism. Hospitals have been co-opted by public health authorities in the construction of advanced bioterrorism surveillance systems. Hospitals have also been directed by local, state and federal authorities to enhance their readiness for decontaminating chemical, biological and nuclear casualties, and for providing emergency triage, stabilization and definitive care in disaster contexts. There are many reasons for cooperating with these (largely un-funded) government mandates. They are linked, for instance, to JCAHO certification, which is linked in turn to Medicare reimbursement. Disaster preparation can also be a good marketing ploy (and conspicuous disaster failure a public relations black eye). But, putting these motives asides, is it a patriotic duty of hospitals to prepare for terrorist attacks? Should hospitals cultivate patriotism in their own ranks by aligning their mission with the memory of 9/11 and with other memories that define the United States as a kind of community? Or is disaster preparedness an entirely generic, non-political response to the mandate for healing? There are several reasons for favoring the latter interpretation. First and foremost is the concern that patriotic rhetoric could degenerate into jingoism, or a kind of pro-American elitism. This would detract from the unqualified nature of hospitals’ response to human suffering and place non-Americans (or Americans with the wrong ethnic backgrounds) at risk. Second, a sense of patriotism or civic duty could dilute the independent self-image of hospitals and healers, and could diminish their focus on medicine’s primary task: healing actions. Third, a sense of patriotism could overwhelm the critical impulse and hence stifle the constructive, dialectical interplay between hospitals and political bodies. Hospitals, at their best, are not government agents. They serve patients. No patriotic response could succeed without attention to these possible pitfalls. Nevertheless, it should be possible to cultivate patriotism while avoiding them. If government is truly "of the people, for the people and by the people," as Lincoln maintained, then dualism between serving patients and serving the polis is false. Indeed, clinicians serve the polis primarily by serving patients. Sometimes patient advocacy will elicit disagreements about public policy. Such disagreements are an expression of patriotism, not its opposite. Nor does patriotism require ethnic distinctions or selectivity in the response to human suffering. To the contrary, a great virtue of patriotism in healthcare is that it could be a strong humanitarian motive. Conclusion Patriotism is valuable because: (1) it mobilizes our moral energies by inspiring loyalty, (2) it fortifies the connection between healthcare providers and the communities they serve, and (3) in its non-degenerate forms it contributes to the cultivation of a larger, all-inclusive community of humanity. Hospitals should respond patriotically to the mandate for terrorism preparedness. Presumably this response would involve efforts to honor the victims and the rescuers who labored and died on September 11th, to cultivate a community of memory, and to cooperate energetically in designing and implementing consequence management strategies. Healthy patriotism does not beget simple acquiescence to government orders. Hospitals are justified, for instance, in calling government to task for its meager financial support of hospital disaster preparedness measures.4 So regarded, a patriotic hospital with patriotic clinicians is an asset not only for the country, but for the freedom and health of all people. 
Griffin Trotter, MD, PhD
Questions for Discussion
|
|
 |