Is medicine a model for ethics in economics?

from Peter Radford

A recent correspondent asks whether medicine could act as a template for the importation of ethical standards into economics. On balance I don’t think it can. Here’s why:

Medicine consists of a practical part that faces outward towards its customers. We call those customers patients. From the earliest times medicine has adopted the credo ‘first do no harm’ which forms the ethical bedrock for all subsequent standards. This is relatively easy to do since ‘doing harm’ is quite quickly identified. Even then such an ethical background failed to stop the development and implementation of some outrageous and harmful medical techniques. In the modern era the ‘doing no harm’ ethic has allowed the creation of a number of rules that govern doctor activity and provide a measure of protection to patients. Those rules are enforced by various governing bodies that not only establish and monitor the rules, but also govern the very process that allows someone to call themselves a doctor in the first place. This governance structure gives practical medicine a coherence and shape that are identifiable by the public, and ensures that the profession recognizes it relationship with society at large.

Medicine also has an academic part that focus not on patients but on research, the development of future cures, and on public policy issues. This part also adheres to the ‘do no harm’ ethic, but in a more loose and less immediate fashion. The background of ‘do no harm’ provides a setting for academic debates about the efficacy of various treatments, drugs, and policies, but does not diminish that debate. It channels it. All participants would agree that at the end, when new treatments, drugs, or policies move from the academic arm of medicine into the practical arm they must rise to meet the standards the profession sets for itself. Prior to that research is governed more by the ethics of scientific discovery which may have a less rigid set of standards, but which are recognizable to the research community and which, ultimately, help ensure the overall profession can maintain its ethical standing once the product or that research is made public.

Economics too has two parts, but they are often conflated into one. A professor may both research and teach. Often that same person may offer policy advice. This conflation leads to an easy muddle. Academic freedom to pursue debate over the efficacy of various theories leaks into a similar freedom to advocate policies based up in those various theories. Consequently there is little or no separation between the research and the practical arms of economics. Academics want to defend their right to argue and debate, but they also want to advocate policies without the profession first reaching closure on what is acceptable theory. This is a sharp distinction with medicine where what is acceptable treatment is quickly propagated throughout the practical side of the profession.

Medicine has a coherence that economics does not.

Worse still is the fact that some economists have assumed theoretic closure and have thus excluded from both their teaching and their policy advocacy theories that do not fit within their closed system of thought. They evade debate and thus represent themselves, falsely, as being complete.

Arguments over the efficacy of Keynesian style remedies to the recent crisis are a good example of the difference between medicine and economics. The lack of closure, inclusion, and agreement within economics leaves two or more sometimes contradictory ‘treatments’ available to the public. The so-called experts within the profession are exposed as having arrived at no conclusion and, instead, offer up a torrent of alternatives that leaves the onus of solution selection to the non-experts. Naturally, this leads to a selection process based not on efficacy but on some other criteria such as political preference. The upshot is that economics with a degraded as social value, but continues as a nice academic pursuit as debate rattles on.

The ultimate point being that you cannot enforce an ethical standard on the profession when there is no coherent set of ‘treatments’ both recognizable and doing no harm. The lack of settled theory prevents the emergence of governance within the profession and thus limits the social value of all the thinking going on within academia.

The only way out of this bind, as far as I can tell, is for the profession to acknowledge that economics does not exist as a coherent program or set of ‘treatments’. It is a melange of competing ideas each of which may contribute at different times and in different settings. It is also a deeply contingent set of ideas, with the context of time and place being of the utmost importance. An ethical stance based on this shifting foundation requires a humble and plural approach. Economists don’t know much of lasting substance. They have identified few, if any, fundamental laws. And they have failed, after two hundred years or more, even to agree on the diseases they should treat. This is a pedagogical nightmare that ought to enforce a plural syllabus, and is representative of a field so divided that it ought only issue a caution-laden set of policy advice.

For instance someone whose theory precludes involuntary unemployment is deeply ethically challenged when they offer advice on the issue of unemployment. How can they? They are, in effect, saying there is no disease to treat. Yet, manifestly, there is a symptom. So they identify something else to cure. The symptom persists. Their cure continues to fail. And no one pays a price for doing harm.

This, of course, assumes that we can agree on what ‘harm’ is in the context of the economy. Whereas in medicine we can.

So: is medicine a model for ethics in economics? No. At least not yet. Medicine exists as a coherent body of thought with agreed upon treatments and an agreed upon relationship with society. Economics does not exist in that way and refuses to acknowledge its social relationship. Medicine is a profession. Economics is not. So medicine can have standards and governance. Economics cannot.

Perhaps it is easier to see this if we accept that economics is simply a subtext to politics. Then we can accept the futility of an expectation of either standards or governance. Ideology and personal world views clutter up our thinking too much. The best we can do is to accept certain rules of civility, let economists go about their irascible arguments, and accept that economics can never achieve the social contribution that modern medicine has attained.

You cannot apply standards to something that doesn’t exist. Economists seem to like it that way. They call it academic freedom.