Printer Friendly

Professional turmoil in Hungary.

Professional Turmoil in Hungary

Taxing Tips. Interwoven in the health care system of most socialist countries is the practice of tipping, a phenomenon in which patients or their relatives give money, gifts, or various favors to physicians either before, after, or during treatment. When tips are given in advance, they clearly represent a bribe; in other cases they are genuinely motivated by gratitude. However, tipping can create uneasiness, mistrust, and embarrassment in patient-physician relationships, and tension and envy among specialists.

In Hungary, the extremely low salary of physicians, the level of which was established after the Second World War, seems to have justified the acceptance of tips and other forms of benefits. In the 1970s however, state health administrators launched a campaign against tipping, one that was doomed to fail. They publicly condemned physicians for taking "envelopes" from patients, but failed to enforce their rhetoric against those in prestigious positions. Although ethics committees were established in every county, primarily for the purpose of eliminating tipping, they have proven too weak even to dare criticizing the biggest recipients of tips. The health adminstrators appear to have concluded that it is better and cheaper to let consumers subsidize physicians than to raise salaries.

The issue took a new turn in January 1988, when for the first time ever, the state began to tax every form of personal income and included physicians' tips as taxable income. Physicians are outraged: A practice that has been for several years a subject of criticism is now to be tolerated and to become a source of state revenue. The profession defends its practice by pointing out that tipping has so infiltrated every dimension of life in the society that it is malicious to single out the medical profession. Of course, no recipient of tipping is about to declare the actual amount of the tips regardless of the threats of tax offices.

Moreover, the taxing of tips requires revision of a basic ideological tenet. Socialism is held to be superior to capitalism on the grounds that it ensures both full employment and free medical care to all. Yet this view becomes untenable once the reality of the practice of tipping is acknowledged.

What is clear is that either the idea of a "free, equal, and high level of health care to all" has to be given up, or physicians have to be paid adequately. Currently, Hungarians are content to "wait-and-see," but the stake is not small: It is a matter of having a tolerable or utterly malfunctioning health care system.

A Rejected Medical Ethical Code. A subject of discussion in the Hungarian medical profession for several years has been the need to create moral guidelines for physicians. The suggestion was partly based on the idea that since there are medical ethics committees and institutional ethical councils, there must be a need for a moral code so the committees and councils can judge what is moral and what is not. A principle that obliged physicians "to uphold the moral rules of the socialist society" was considered too vague to assist in determining whether certain behavior conformed to "socialist morality."

A panel of eight prominent physicians was assigned the task of writing the Medical Ethical Code. The panelists were selected based on an assumption that they had obtained their ethical wisdom through long years of clinical practice. Not surprisingly, then, the code itself emphasizes that experts in medical ethics are those who hold top positions in health administration and/or are older physicians.

At the outset, the panel's deliberations were hindered by differences over the real purpose for the code. Many health administrators, health politicians, and even ethicists in Hungary equate law with morality, and so saw no need for such a code. One important topic for debate thus became whether the code should complement or contradict the laws.

Though the authors of the code pledged not to articulate rules in conflict with the law, they clearly failed throughout its 120 pages. For example, based on the socialist claim that the life of a human being is of absolute value, the law requires physicians to do everything possible for patients, even for those considered to be beyond efficacious medical treatment. In the code as drafted, however, though the authors strictly avoided the language of "euthanasia," they did use phrases such as "limited care" and "local principles of DNR." And while the code repeatedly affirms a principle of "unconditional respect for life," it is not clear whether this applies to the lives of bugs, Hungarians, or human beings in general.

The code also declared that "medical ethics is under the control of the ethics committees." The authors failed to explain how a branch of science could ever be controlled or managed by committees, whose members are, moreover, well known to be lacking expertise in ethics. The validity of the Code was also undermined by the particular concerns of the panelists, some of whom wanted to advance the interests of their own fields. The importance of intensive care was overly dramatized amid appeals for expanded financial support.

The proposed Medical Ethical Code was distributed by the Ministry of Health to designated medical and legal associations, and after some heated debates, was rejected by a majority of these societies. A complete silence now surrounds the first would-be code of medical ethics in Hungary.
COPYRIGHT 1988 Hastings Center
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1988 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:tipping and medical ethics
Author:Blasszauer, Bela
Publication:The Hastings Center Report
Date:Aug 1, 1988
Previous Article:Controlling Life: Jacques Loeb and the Engineering Ideal in Biology.
Next Article:Animals in the classroom.

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters