The Being of Leadership

The commercialization of health care continues to undermine the deeply rooted ethical foundation of medicine as a profession that values service above reward. In this market-driven environment, write Kirch and Vernon, "physician autonomy at times appears to have become more aligned with ... the right to enhance physician revenue [such that] attention to social justice may be decreased" [1]. The four prima facie principles of medical ethics - beneficence (doing good for the patient), nonmaleficence (do no harm), respect for patient autonomy (patient choice), and justice (ensuring fair and equal treatment) - and the more recently developed Charter on Medical Professionalism [2] are routinely challenged by a health care system where the business of medicine has become business.The issues at stake here are not esoteric or academic. Moreover, a culture in which personal gain trumps societal needs is not an illusion. The percentage of Americans who agree that higher income families should contribute more in taxes to help cover the cost of health care for lower income families decreased from 66% in 1991 to 39% in 2006 [3]. Thus, "it is important to discuss how the commercialization of medicine has fostered a distortion of emphasis among the basic tenets of medical ethics" [1]. In tackling this dilemma, physicians and other health care leaders must be front and center in the dialogue.As central players in the social contract, physicians are granted standing, privilege, and generous remuneration with the understanding that they will adhere to the principles of service and altruism. As key players and regulators in the distribution and consumption of health care goods and services, physicians have an ethical responsibility to step back and examine their personal leadership role in creating a just society. Lee writes [4], "[H]ealth care today needs ... a new kind of leadership...; strong leaders and a [new] cultural context in which they can lead." In creating this new paradig