What Constitutes a Just Match?: A Reply to Murphy  

Oleh:

HESTER, D MICAH

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Cambridge Quarterly of Healthcare Ethics (keterangan: ada di Proquest) vol. 12 no. 01 (2003), page 78.

Ketersediaan

Perpustakaan FK Nomor Panggil: C01.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

In April of 2001 I published a brief commentary in the journal Academic Medicine questioning the current character and functioning of the National Residency Matching Program (or lithe match," as it is known in medical schools and teaching centers).l The purpose of the article was to stimulate a rethinking of process. At 50 years old, the environment through which the match operates (and has helped to create) has changed, and as such I thought it time to ask ourselves whether or not the match, its algorithm, and, more important, the values it manifests might well need an overhaul. Timothy Murphy's article, "Justice in Residency Placement,"2 is an attempt to work through ethical issues raised by the match and to do so using my own commentary as his foil. It is to Murphy's credit that he takes up my call to converse on this matter in a positive and well-considered way (letters to the editor of Academic Medicine, published in November of 2001, did not strike me as quite so generous and affable). However, although it is clear that Murphy has correctly noted important problems with my commentary} in the end I believe that he missed the point of some of my argument. The primary focus of my original commentary was on the competitive charac¬ter of the match and my concern that this kind of competition is counterproduc¬ tive to the aims of medicine itself. Based on a claim I believe to be uncontroversial¬namely, that means are constitutive of the ends they produce-I argue that competitive means produce competition. Competition, although capable of pro¬ducing positive, progressive behavior-such as inner resolve, extra effort, and so forth4-creates also the danger of divisiveness, underhandedness, and cruelty. Actualizing such negativity depends on a great many factors, but such danger is always there, lurking, waiting to be stimulated into being. The match, and much of medical education for that matter, is competitive and therefore runs the risk of producing truly negative behavior. However, as a profession, medicine aims at something else. Medicine aims at healthy living for patients. As I have argued at length elsewhere, healthy living is intimately tied up with intelligent habits of community where cooperative and participa¬tory behaviors are nurtured.5 As such, the ends of medicine have no place for the negative side of competition. Of course, this says nothing about the positive behaviors that can arise in competition, and those I listed above, such as resolve and effort, have the potential to be of great benefit to "community as healing. II What is not clear is whether competition is necessary to develop those positive behaviors we might all agree can follow from it. I suggest that surely it is not the only method and, in fact, other methods have a decided advantage because they do not come with the same risks that competition does.

Opini Anda

Klik untuk menuliskan opini Anda tentang koleksi ini!

Kembali