HOW DOCTORS CAN THINK HEROICALLY

Kohlberg stages pre- conventional conventional post- conventional
What is the orientation? heteronomous intstrumental and relative interpersonal conformity social system law & order social contract universal ethical principles
What takes precedence? Avoid punishment. Satisfy my need. Meet expectations. Fulfill duties to the highest law. Live the spirit of the local law if it does not prescribe what to do. Fulfill duties to universal/global principles (justice, right to life).
As a doctor, what should I do? What will I lose if I help? What will I gain if I help? What will people think of me if I help or don't help? How will I live with myself if I don't help? What will happen to this person if I do not help? What would I answer to God if asked why I made my decision?
example
What do I charge this patient who has no insurance? because I could will not upbill in case I get caught and fined. I will not upbill because I could get a bonus for no errors on my audit. I will ask for a reduced charge because it would look bad on my group and me to charge full price. I will ask for a reduced charge on a sliding scale because putting the patient into medical debt is bad for society and my business can afford it. I will ask for a reduced charge on a sliding scale because I have a moral obligation to provide healthcare services at prices people in my society can afford. I will advocate that this patient not be charged beyond what he can afford because my moral call is to inch myself and society toward perfection, which means I must uphold justice in this matter.

Michael Young's definition of heroism:

situation:

• facing uncertainty in the likelihood of overcoming a challenge 




intent:

•to overcome the challenge despite knowing the attempt may mean losing something of great personal value (= courage)


•to act because the effort is morally right


•to benefit someone else, especially someone who can’t fix the problem on their own (= altruism) and not to obtain extrinsic personal rewards like fame/money




behavior/response:

•giving more than customary/ordinary effort