Too big to fail: health care’s moral quandary

This could be the mythical and mystical tale of organized health care. Humans and their systems may become organized to evolve as large and stable entities, as disorganized ones may never grow large and may remain perpetually unstable, risking disintegration. However, once they reach the status of being “too big to fail” and become self-aware of this situation, the lines between ethics, morality, and legality may begin to blur. This may become unavoidable because survival may take precedence, considering that the entire existence may be at risk of disintegrating into disorganization if something too large is allowed to fail.

Patients need not worry since their care is not paid for directly by them. Providers need not worry because the care they provide is compensated for somehow. Payers need not worry as contributions flow their way somehow. Regulators need not worry, with political action committees paving the way for their elections and re-elections. It all remains ethical, moral, and legal as long as serving someone, somewhere, doesn’t impose an excessive cost on anyone else, somewhere else. While humans and their systems may become overly complex and complicated, they simply cannot exist without a sufficient level of organization.

Essentially, when serving humans and their systems begins to impose too great a cost on someone (such as humans) somewhere (such as systems) else, even essential services may start to seem like avoidable servitude with questionable ethics, morality, and legality until and unless ethics, morality, and legality continuously evolve to accommodate the concept of “too big to fail.” This doesn’t mean turning a blind eye to ethics, morality, and legality, but rather shedding new light in the form of new ethical norms, morals, and laws when the situation demands it.

Deepak Gupta is an anesthesiologist.

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