What You Should Know About the Ethics of Bribery

Medical ethics often concern issues of doctor-patient confidentiality, of the primary factors that should affect the doctor's decision-making processes, and of the limits of a doctor's power. But one of the major issues of medical ethics that doesn't necessarily concern directly dealing with the patient is the acceptance of bribes. Doctors are often offered bribes by pharmaceutical companies in an attempt to have those doctors prescribe the pharmaceutical companies' drugs more often. To do so would put the doctor in conflict with primary principles of medical ethics, however, such as the importance of putting the patients' interests first, as prescribing certain drugs more often when those drugs are either unnecessary, dangerous, or ineffective is clearly not in the best interests of the patient. There are other forms of bribery in the medical profession, however, and these forms of bribery are often most indicative of a lack of medical ethics. In Romania, for instance, aspects of the country's near-institutionalization of bribery during its tenure as a Communist nation still thrive strongly in its medical culture, as doctors practically require bribes of very high value to perform their jobs. As an example, take Alina Lungu, a thirty-year-old pregnant woman who made a number of bribes throughout her pregnancy. She paid 200 euros to her gynecologist, 25 euros to her nurse for an epidural, and even 10 euros to her orderly to make sure he didn't drop her when she was on the stretcher. Even just this is clearly in violation of any understanding of medical ethics in America. But the story grew worse, as Lungu's gynecologist did not arrive until long into Lungu's labor. The result? The umbilical cord wrapped around Lungu's baby's head and caused blindness, deafness, and brain damage. Had the doctor arrived earlier, then all such damage might have been averted. The fact that not only is bribery a major element in the Romanian medical system, but also bribes of large amounts are necessary to secure even the most basic of expected medical services, is clearly a major problem of medical ethics in Romania and similar countries. America is fortunate not to have such a breach of medical ethics, so consistently present in its medical system. But too often, the difference can be one merely of degree, not kind. Even if Americans don't need to give such blatant, exorbitant bribes to medical professionals in order to obtain medical services, the fact remains that the medical ethics of American doctors are just as threatened by the acceptance of bribes from the pharmaceutical companies. Doctors have certain overruling ethical practices, which are important because of the basic nature of what doctors do. Doctors serve patients, helping them to recover from ailments or to overcome illness or injury. Their purpose is to help people. When they purposefully eschew this purpose for the sake of accepting bribes, they are in breach of medical ethics regardless of exactly what the bribe is for. Even though the bribes of pharmaceutical companies, leading to increased prescription of certain medicines, feel very different than the bribes that Alina Lungu made, which still failed to bring her proper care, they are both part of a system of bribery which undermines the very purpose for the doctors' existence. Legal issues aside, such bribes must be excised from the system for the sake of the integrity of the medical profession.