Wednesday, December 8, 2010

Trust in a Social Role: Key Concept

I apologize if at times this blog seems to turn into Health Care Renewal Blog West, where I just refer you over to something that just appeared from our friends at HCR. A nice post by Dr. Bernard Carroll, however--

--requires brief comment here because it makes an important point so well.

Dr. Carroll uses the impeachment hearings of a Louisiana Federal judge as his starting point. It would be understandable, but wrong, to see these impeachment hearings as aimed at humiliating or punishing Judge X. Impeachment, Dr. Carroll notes, is actually a quite different concept. It aims to protect the institution, not attack the individual. If an individual is acting in a way to bring disgrace onto the institution (in the case the judiciary), then that person must be removed--and the standards of evidence required to justify the removal are less than what would be required to prove guilt in a court of law.

Dr. Carroll goes on to list a number of instances from his own field of academic psychiatry, where the medical-school equivalent of impeachment would have been warranted. But for us the issue is not giving more examples, but seeing how this insight from the impeachment analogy focuses us on the critical background notion behind "conflict of interest." As I explained in HOOKED, and drawing on the analysis by philosopher Ed Erde, you don't "get" conflict of interest until you see that the underlying idea is trust in a social role. The goal in talking about conflict of interest is not to play "gotcha!" with the doc who has his hand in the cookie jar at the present moment; it is to try to preserve public trust in medicine against the damage done by the general impression that such behavior creates.

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