medicine … covenant or contract?

“In law school he had committed acts which had formerly seemed to him of great vileness and had inspired a feeling of self-loathing in him at the time he committed them; but subsequently, seeing that such acts were also committed by highly placed people and were not considered bad, he, without really thinking them good, forgot all about them and was not troubled in the least by the memory of them.” The Death of Ivan Ilyich – Leo Tolstoy ch 2

“It is towards the end of training, however, that moral thinking becomes a luxury and debt and young families refocus long-range plans.  For too many, choosing a practice is no more than choosing a job with contracts, covenants, and revenue triggers for bonuses or eventually a partnership.  It is not that physicians explicitly seek to do badly for their patients.  It is more that the “real world” resets how good, diligent, selfless, and honest they can afford to be.  Time does become money.  So, for reasons that seem “mature,” the moral strictures are subtly loosened.” Doctor’s Loss of Moral Agency – Levine and Wallach