Medical Ethics and Physician Motivations

This paper provides an institutional economics framework for analyzing medical ethics: ethical policies are partitions of a set of possible physician actions into ethical and unethical subsets, where unethical actions are unavailable (or sufficiently heavily penalized) in future decision making. Individual doctors' preferences over these policies combined with a political process determine equilibrium constraints. Examining a general model of physician support for `liberal' versus `restrictive' ethics, I show that altruism for one's own patients and concern for all patients have different implications. The latter motivation may justify restrictions on physician behavior, but this argument rests on heavy assumptions. Even identical physicians might ban actions they would otherwise select for reasons varying from solving commons-type problems in patient welfare to differences in the costs of maintaining ethical policies, but heightened altruism for others' patients makes the former reasoning less credible. Novel models for the ethics `Provide Free Care to Physicians' and `Duty to Treat in a Pandemic' demonstrate how shifting economic parameters predict the realized evolution of formal ethical rules. Key model predictions include: (i) rising physician income can explain long-run weakening of both formal ethics in the United States; and (ii) the duty to treat can deteriorate as the ability for a small number of physicians to improve pandemic outcomes increases.