Lessons From History: The Ethical Foundation of VA Health Care

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There are health care experts, politicians, even ethicists, who have called for either complete overhauling or dismantling of the old and swaying VHA edifice and furloughing or firing its demoralized and overworked staff. But before the wrecking crews come in and the ranks of committed and competent VA employees are sent packing, the naysayers should stop and realize that no matter what may be gained in that process, we will have profoundly changed the founding purpose and mission of the VA. The VA has one reason for existence—to care for veterans. Long before patient-centered care and medical homes were bywords in health care parlance, they were the words of ethical justification for the VHA as a health care agency. No moral agent, be it a person or an institution, can serve 2 masters. The VA is the only major health care system in the U.S. that does not have dual and often conflicting interests, whether in mission-readiness, profit, religious faith, or local and state politics.

There may be disagreements about the nature and scope of VHA’s problems and their solutions, but we should all recognize that a deeper ethical problem exists if the federal government and VHA fail to fulfill the obligation of reciprocity so eloquently described by President Lincoln. Economics can inform and empower but never fully resolve what is at the heart an ethical issue. Accountability and integrity are fundamental ethical values that are easily eroded by a singular and punitive focus on rules and rule-breaking that have guided too much of VA’s action and inaction, as well as the reaction of Congress. The military motto is to “leave no solider behind.” President Lincoln created the VA to honor this promise to veterans when they returned to civilian life. We must not allow engagement in partisan clashes to prevent us from fulfilling our moral commitment to those who actually fought and supported the nation’s battles.

The editor thanks Virginia Ashby Sharpe, PhD, for her insightful comments on an earlier draft of this editorial.

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