SECTION TWO: THE PRUDENTIAL ARGUMENT FOR PROFESSIONAL DIVERSITY

At this point, our argument takes a rather different direction. We contend that (ethics aside) a profession that is more diverse in its membership will be more excellent in the execution of its functional tasks than one that is not diverse. For purposes of clarification, we will term functional excellence, the prudential argument. Our prudential argument has two parts: a) the matching argument, and b) the social evolution argument. These will be addressed in order.

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So far this essay has contended that morality demands proportional diversity in the professions (based upon the puzzle-maker model of merit). This section will also argue for the ethical foundations of proportional diversity within the professions via an argument that goes to the nature of professional ethics itself: the contract with the host society. On a general level, professions can be said to operate because of a contract with the society. One version of this contract can be seen in Figure 2.

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SECTION ONE: THE MORAL ARGUMENT FOR PROPORTIONAL DIVERSITY

In this section of the paper, two aspects of the moral argument will be explored. First, a general moral argument will be presented on the basis of merit considerations. Second, an argument based upon professional ethics will be put forth.

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INTRODUCTION

To begin, it is important to introduce the two authors of this paper. Richard Grant is an orthopedic surgeon with national credentials serving on numerous governing boards. Michael Boylan is a philosopher who has written on medical ethics. The two of us began this paper over a year ago in various discussions we had together and decided that given what we feel is an increasingly hostile climate to minorities in the United States, it was time for those who felt differently to speak out.

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Our patient is unique in that he has ischemic cardiomyopathy with a focal origin for his VF. Polymorphic VT/VF and electrical storm occurring in this setting are often attributed to acute ischemia or electrolyte abnormalities, and this was not noted in our patient. Although focal origin of VT and successful catheter ablation of VT have been reported for more than 15 years, focal ablation of VF has been reported for the first time in 2002 in patients with idiopathic VF. Our case preceded these reports and is the first one describing transcatheter ablation for VF in ischemic cardiomyopathy.

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A 65-year-old male patient with a history of coronary artery disease (bypass grafting 10 years ago), diabetes mellitus, hyperlipidemia, and peripheral vascular disease experienced persistent substernal gripping chest pain and was evaluated in the local emergency room. He was found to be pale and diaphoretic, with runs of nonsustained VT. He was started on intravenous nitroglycerin, heparin, and eptifibatide, and transferred to our facility for suspected acute coronary syndrome. His cardiac enzymes showed a creatine kinase (CK) of 171 u/1 (39-195 u/1), CK MB fraction of 3.2 u/1 (0.0-5.0 u/1), and troponin T of 0.01 ng/ml (0.0-0.1 ng/ml). His serum creatinine was 2.1 mg/dl (0.5-1.4 mg/dl), drug sodium 135 meq/1 (135-145 meq/1), potassium 4.1 meq/1 (3.5-5.0 meq/1), magnesium 2.3 mg/dl (1.7-2.5 mg/dl), generic calcium 9.0 mg/dl (8.5-10.2 mg/dl), and albumin 3.3 g/dl (3.5-5.0 g/dl). Echocardiogram showed mildly dilated left atrium, dilated left ventricle with posterior hypokinesis, and an ejection fraction of 40%.

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INTRODUCTION

Three-hundred-fifty-thousand patients die each year of sudden cardiac death alone in the United States. Ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) are the major causes of sudden cardiac death. Patients who survive an episode of sustained VT or VF have a recurrence rate of 30% in the next year, which increases to 50% in two years. …..Click here to read more