Viewpoint: Interests, rights and standards of care in the context of globalized medicine

Is medical ethics doing its job?

“…Hille Haker argues in her viewpoint that with regard to fundamental notions in medical research ethics such as respect for autonomy, also, there are ideological premises that influence our understanding [20]. The rights of patients were first spelled out in the background of the ideological misuse of scientific research under the Nazi regime in Germany and were codified in the Nuremberg Declaration.…”

Commentary: Autonomy revisited - a response to H. Haker

“…This means that respect for autonomy in medical ethics must mean respect for patients as moral agents, who are capable of taking responsible choices out of consideration for the needs and rights of others, as well as their own needs and wants. Such a view of autonomy casts some of the problems mentioned by Haker in different light [2]. It could mean helping the teenager in her example to resist the current image of feminine worth as having big breasts, and it could give greater authority to the notion of community well-being, contained in the microbicide trial example.…”

“…[3] If we leave this kind of naïve individualism unquestioned, we quickly erode the basis of morality itself, because this surely depends on reciprocal rights and obligations between ourselves and others (as Haker notes in her paper [2]). …”

“…This may not be the only example of an ideological bias in modern medical ethics (another might be the favouring of 'rescue medicine' over long-term care, with its attendant denial of both morbidity and mortality), but I do agree that we need to look very carefully at both the interpretation and the practical applications of the concept of autonomy. Thus, my response to Haker will not be negatively critical of her main conclusions [2]. Instead, I will amplify two aspects her argument.…”

“…It suggests that our claim to be acting ethically may in fact be poorly concealed imposition of an inappropriate ideology, which is to the detriment of patients. Invited to make this kind of critique of modern medical ethics, Haker has singled out respect for the autonomy of patients as the chief culprit [2]. This may not be the only example of an ideological bias in modern medical ethics (another might be the favouring of 'rescue medicine' over long-term care, with its attendant denial of both morbidity and mortality), but I do agree that we need to look very carefully at both the interpretation and the practical applications of the concept of autonomy.…”