[ JBEM Index / Volume 1 / Number 2 ]
The Good Samaritan:
Original and Updated Versions
Dr. Orient was graduated from Columbia University College of Physicians and Surgeons in Philadelphia. She is currently in the solo practice of general internal medicine in Tucson, Arizona. The following is an excerpt from a speech presented by her in 1986 to the Association of American Physicians and Surgeons, of which she is president. She admits that the “original is plagiarized from a famous Rabbi.”
The story begins with a man who fell among thieves. A Samaritan took pity on him, mounted him on his own beast and brought him to an inn. The Samaritan did not deposit him on the doorstep and disappear. Nor did he threaten the innkeeper with loss of his license, or a fine, or sanctions, or disgrace in the eyes of the community, if he failed to provide for the victim’s needs. On the contrary, the Samaritan offered the innkeeper a Roman denarius, a silver coin valued at about nineteen cents, the customary daily wage for a laborer. Not a princely sum, but the innkeeper apparently considered it adequate. The Samaritan even offered to pay more, if necessary, in an early example of cost-based reimbursement. As it is written in Luke 10:35, “`On the morrow, when he departed, he . .. said unto (the host), `Take care of him, and whatsoever thou spendest more, when I come again, I will repay thee’.” The innkeeper evidently trusted the Samaritan’s word. Perhaps he had a reputation for honesty, reliability, and prompt payment. What might be even more surprising is that the Samaritan also trusted the innkeeper not to overcharge him.
Not surprisingly, it was a lawyer who asked the question that the parable is supposed to answer: “Who is my neighbor?”
Today, the question is still pertinent, but the answer of the parable is often distorted. The focus has shifted from individuals to society as a whole, and the number of victims has multiplied. In today’s ethos the people who resided along the highway, or in the next town, or even in the whole nation, might be considered just as responsible for aiding the victim as the priest and the Levite were. And all might be blamed for the societal forces that purportedly created the new victim class, the band of thieves. The original story illustrated the principle of subsidiary – that we should aid those who are close to us – whereas the new ethics emphasizes social responsibility.
The Samaritan was a stranger and a foreigner, but he was the victim’s neighbor in the sense that he was in the right place at the right time, and he had it within his power to render aid. Because he chose to do so, he has been singled out for praise throughout two millennia. But it is doubtful that many of today’s ethicists would consider him to be much of a hero. Didn’t the victim have a right to help? Besides, the Samaritan’s motives might be questioned. He is said to have acted out of a feeling of compassion, so it is likely that he gained some sense of personal satisfaction from his good deed. There were surely many poor or injured people in the region on that very day whom he did not choose to aid, even though he was a prosperous man. Those who follow his example, on the advice of the Rabbi, are even less worthy of esteem – for did not the Rabbi commend his action to the lawyer on the basis of self interest?
This is what you must do, he said, to inherit eternal life. The proffered reward was substantial, and the standards not all that high. The lawyer was just told to love his neighbor as himself – no worse, and no better either.
In the parable, the innkeeper is not the hero, but then he also is no villain. He was probably just a regular fellow with a wife and children to support and bills to pay. It is possible that he was a compassionate man, who gave a little extra to the victim without asking for repayment. We don’t know. But he apparently did not risk the debtor’s prison in order to care for his unfortunate patient. If the Samaritan had not offered the denarius, he might even have performed a “wallet biopsy” on the hapless victim, to find that the wallet had, alas, been stolen. Most likely, the innkeeper provided only the basic services – no cardiopulmonary resuscitation, no coronary artery bypass, no liver transplant, no preventive medicine, no psychotherapy, and probably not even a private room.
The story omits altogether one character who has assumed extreme importance today: the gatekeeper. We can only guess how they managed to do without him. Who was there to see whether there was room in the inn, to hold the denarius for several months, and to make sure that the charges did not exceed the prepaid amount?
Every day you see the consequences of new concepts of responsibility in your medical practice, so you will surely recognize the following, revised parable, told from the perspective of a socially responsible bioethicist.
AN UPDATED VERSION OF THE GOOD SAMARITAN
A man fell among antisocial elements, who had probably had a deprived childhood. (In the absence of property rights, there are, of course no thieves.) A priest and a Levite passed by, and notified the proper agency in charge of prioritizing and providing for the victim’s right to medical care in an efficient and fair manner.
While the bleeding victim was awaiting his turn, a Samaritan came along. The Samaritan was moved by pity (a deplorable trait, since tenderheartedness can lead to favoritism and other evils). However, he had no oil or wine for pouring on the man’s wounds, no beast, and no denarius. Because the business in which he was engaged did not serve the social good, his property had been redistributed to those who needed it more. He was thus unable to help the man.
Eventually, some member of the helping professions brought the victim to the inn, where he was evaluated by the gatekeeper. There was a delay because the man’s identification card had been stole, and it was difficult to verify his eligibility.
Also, the gatekeeper needed to confer with a utilization review advisor, who was more expert in applying the criteria.
The admission criteria had been recently revised by a committee of community-based professional consultants, including the priest and the Levite.
Once the gatekeeper certified that the man was both eligible and needy, he assigned him, by now in a moribund state, to a preferred innkeeper. The innkeeper’s duty was to take care of the patient, for whatever reimbursement society decided upon. In former times he might have gotten a denarius; but in the age of cost-efficiency, he would make do for less, without any decline in the quality of care. Otherwise, he would lose his innkeeper’s. license, or face other sanctions.
An innkeeper who complained that he had fallen among thieves would be accused of greed and selfishness. If he failed to cure the patient, the priest and Levite could accuse him of incompetence or negligence, and the man or his heirs could instigate a lawsuit, with the aid of the neighborly lawyer. The innkeeper’s union, in turn, could complain that society had not provided adequate resources or had allocated them unfairly. They could also propose an additional tax on the Samaritan for programs to alleviate the conditions that lead to roadside crime.
[ JBEM Index / Volume 1 / Number 2 ]