PRN: Morality and Money

Just the thought of money and moralityin the same sentence makes mostpeople uneasy. However, this is yetanother area in our economic systemthat we take for granted. We don't talkor read about this with as much clarityas we could. There are moral and ethicalaspects to everything we do, especiallyas physicians, as we strugglebetween self-interest and competing,wider concerns. How we make moneyand how we spend it—those commonplacesof daily life—can be devilishlycomplicated. But then again, we dohave to get on with things, don't we?

Generating FundsAs doctors, we usually make moneythe old-fashioned way: we earn it. Andwe usually do it by placing the interestsof others first, if temporarily. We bene-fit only after those we are directing ourefforts toward receive their benefit. Asprofessional decision makers we havean ethical prerogative to do so, eventhough study after study shows that allof us can be influenced to bend ourethics, particularly in gray areas wherewe are more comfortable rationalizing.

Oh, you say that you are different?Let's look at pharmaceutical manufacturers.Doctors consistently say thatthey are not influenced to a significantdegree in their prescribing habits bythe drug companies' gifts, meals, trips,and presentations. But the drug companiessee the difference, and that's whythey continue to spend billions. Sure,some of it is informative and helpful,but humans often use rationalization,especially in the many gray areas wehave to deal with, when there are competinginterests and inadequate data.

Passive Income

Let's move from earned income to passiveincome of investments in questionablesources such as tobacco companies.Do the ends justify the means? What ifwe are putting the returns toward achild's education or even a charitybequest? And complicating the decision isthe fact that these types of investmentsoften have an above-average return. Andwhat does it mean when we don't scrutinizeour mutual funds' holdings too carefullyto see if such morally ambiguouscompanies are there?

So how we get our income often hasethical issues woven through. Are wetoo busy to think and take a stand?And, of course, making no decision is avery big decision, indeed.

It logically follows that how wespend and allocate our money also carriesmoral baggage. I know people whowon't buy a German car as long as theWorld War II generation is alive. Howabout the purchase of so-called "blooddiamonds" from central Africa that areright now funding atrocities?

Closer to home, is the purchase ofalcohol the first step down a slipperyslope? Is a lottery ticket a cheap bit offun and a boon to education or a foolishwaste of money that could be putto better use elsewhere? Whether youare a Social Security pensioner whofaces a grim monthly choice betweenexpensive medications and an adequatediet or an affluent physician facingsofter decisions, your moral compassalways plays a role.

But don't blame money itself; it'sonly the intermediary, not the actor.The actor, dear friends, is us. Today, justfor fun, 1 time when your reach foryour wallet, stop for a moment andthink about the moral implications ofwhere your money came from andwhere it might be going. Then moveon. I told you thinking about this stuffwould make you feel uncomfortable.

Jeff Brown, MD, CPE, a practicingphysician who is a partner onthe Stanford University GraduateSchool of Business Alumni ConsultingTeam, teaches in the StanfordSchool of Medicine FamilyPractice Program. He welcomes questions orcomments at jeffebrownmd@aol.com.