Is it ethical to contract for a service you know in advance you'll be unable to pay for simply because you really need it?

It may seem like a simple question with an easy answer, but it's not.

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I too am pleasantly surprised by the figure for teachers.

If you read my post carefully you will see that I stated we pay doctors more because of their education not that their pay is necessarily justified. In my opinion the figure for neurosurgeons you have quoted is not justified.

It reminds me of a similar situation in soccer in England (obviously this is a more trivial example as it does not involve people's health). In England's top league (Premiership) soccer players are paid ludicrous sums of money (top players can make £60,000 a week) compared with the next league down. One cannot sensibly argue that they are that much better at playing soccer.

A lot of people get upset about these inflated salaries because they push the ticket prices up for the average punter. And yet people keep going and paying. It actually makes less sense in this case because, as you point out, you pay the neurosurgeon literally on pain of death. People could just stop going to watch soccer until the prices came down. Weird.

I didn't mean for the gun to the head analogy to become a justification for large fees. Charging someone a lot because they must pay it or die isn't ethically supportable. It's like looting, only it's looting someone's finances rather than a liquor store.

A lot of people get upset about these inflated salaries because they push the ticket prices up for the average punter. And yet people keep going and paying.

To take that analogy and run with it, insurance companies are part of the problem at both ends. On the one hand, they maximize thir profits by excluding people based on their probability of actually needing insurance in the first place. At the other end, while they do often limit payouts through negotiations, they still do go ahead and pay many of these extravagant fees, which just encourages doctors to ask for huge rewards.

BTW, emergency room doctors also save lives and often in really dire situations, yet how many ER specialists make anything close to a typical average neurosurgeon?

When do we 'compromise', an ethical principle?

My standing positions

A)I desire to treat others, as I would like to be treated.
B)I desire to make sure that people are treated as 'ends in themselves'.
C)I desire to maintain a large scale social context where the 'greater good'
is preserved.
D)I believe that part of the 'greater good', is preserved by respecting
the needs of others, and not resorting to excess greed or neediness.
E)I believe that another part of the 'greater good' is deeply dependent upon
the vast context that we and all life depends.

Being 'unable to pay' is based upon the social contexts we find ourselves. I expect that most of us will pass through periods when we fail our most deeply held beliefs about our integrity and maturity. Now deeply we fail, might say something about the 'self', or about the 'culture' we are part of.

I have been out of work for about 18 months. It is unclear how much this is about 'me', and how much this is about 'culture'. I visit with people at employment meetings, at the employment office, and on the street. Sometimes they seem to be only looking for a handout, a freebe, or an 'escape'.

At times my boordom is nearly overwheming, but I do like being in the world. So I study, read, expand my horizens, volunteer, garden, etc. I do not 'escape', I do not 'hide' from the world. Inspite of my nearly 'non-moneied' statis, I offer my understanding to others, and make an honest attempt to extend the local human
enterprise with out degrading myself and the lives of others.

I have reduced my needs to basics, so I might not disturb others with my burdens, and offer my skills to improve their lives were I can.

While none of this has a 'perfect positive affect', I am still a 'good man'..

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