Medicine, morals and money have, for centuries, lived in uneasy
cohabitation. Dwelling in the social institution of care of the sick,
each needs the other, yet each is embarrassed to admit the other's
presence. Morality, in particular, suffers embarrassment, for it is
often required to explain how money and medicine are not inimical.
Throughout the history of Western medicine, morality's explanations have
been con- sistently ambiguous. Pla.o held that the physician must
cultivate the art of getting paid as well as the art of healing, for
even if the goal of medicine is healing and not making money, the
self-interest of the craftsman is satisfied thereby [4]. Centuries
later, a medieval medical moralist, Henri de Mandeville, said: "The
chief object of the patient ... is to get cured ... the object of the
surgeon, on the other hand, is to obtain his money ... ([5], p. 16).
This incompatibility, while general, is not universal. Throughout
history, medical practitioners have resolved the problem - either in
conscience or to their satisfaction. Some physicians have been so
reluctant to make a profit from the ills of those whom they treated that
they preferred to live in poverty. Samuel Johnson described his friend,
Dr. Robert Levet, a Practiser of Physic: No summons mock'd by chill
delay, No petty gain disdain'd by pride; The modest wants of ev'ry day
The toil of ev'ry day supplied [3].