Patient Autonomy and the Ethics of Responsibility
http://www.100md.com
《新英格兰医药杂志》
Like many other physicians, Alfred I. Tauber, a professor of medicine and director of the Center for Philosophy and History of Science at Boston University, intensely dislikes the influence that apprehension about the law currently exerts on the practice of medicine in the United States. Unlike most members of his profession, however, Tauber does not place the blame for the law's dominance of contemporary medicine (as evidenced by the obsession that providers have about risk management) on the shoulders of greedy lawyers, timid judges, misguided legislators, or opportunistic patients. Instead, he mainly faults physicians themselves for succumbing to economic and organizational influences and permitting society to substitute a legal-contract model of the patient–physician relationship, in which the ethical principle of autonomy in the form of individual self-determination is made operational in the legal doctrine of informed consent, for the virtues of trust and trustworthiness that ought to characterize a superior patient–physician model — namely, an ethics of responsibility instead of rights.
Tauber notes, for example, that "most would concur that when the law must be invoked, normal trust has been replaced by a procedure of mechanistic design. Law appears when trust fails." In addition, he writes that "contracts serve as poor substitutes for a more fluid interaction. Once mistrust is established, the law only can adjudicate the dispute."
Tauber's mission is to correct the way the law, as well as its bioethicist and managed-care enablers, have shortchanged the moral character of medicine by overemphasizing the prerogative of patients to choose treatments at the expense of their right to be treated compassionately. Tauber seeks to turn the prevailing concept of patient autonomy on its head by getting physicians to act on their moral duties to their patients, as well as by persuading patients to trust their physicians enough to choose to defer to the medical expertise of professionals who are bound to act in the best interests of their patients. Tauber would establish his humane replacement of the inhumane status quo through a three-part strategy of complete conceptual transformation of medical education to meld scientific knowledge with a greater sensitivity to moral values, infusion of exposure to ethics into clinical education not just for specific problem-solving purposes but also to humanize the ethos of care, and persuasion of institutional providers to create a section on ethical concerns in every patient record.
This book is not intended to be a practical aid for applied clinical ethics (disparaged as "thin" ethics). Rather, Tauber lays out a detailed exegesis of the philosophical principles underlying his view of the shortcomings and the amelioration of modern medicine. The resulting book is impressively referenced and written and is an intellectually elegant exercise in moral philosophy. However, it is written self-consciously in a language and style that will make it far more accessible to, and appropriate for study by, an audience of serious academic philosophers than one of practicing physicians.
Marshall B. Kapp, J.D., M.P.H.
Southern Illinois University School of Law
Carbondale, IL 62901
kapp@siu.edu((Basic Bioethics.) By Alf)
Tauber notes, for example, that "most would concur that when the law must be invoked, normal trust has been replaced by a procedure of mechanistic design. Law appears when trust fails." In addition, he writes that "contracts serve as poor substitutes for a more fluid interaction. Once mistrust is established, the law only can adjudicate the dispute."
Tauber's mission is to correct the way the law, as well as its bioethicist and managed-care enablers, have shortchanged the moral character of medicine by overemphasizing the prerogative of patients to choose treatments at the expense of their right to be treated compassionately. Tauber seeks to turn the prevailing concept of patient autonomy on its head by getting physicians to act on their moral duties to their patients, as well as by persuading patients to trust their physicians enough to choose to defer to the medical expertise of professionals who are bound to act in the best interests of their patients. Tauber would establish his humane replacement of the inhumane status quo through a three-part strategy of complete conceptual transformation of medical education to meld scientific knowledge with a greater sensitivity to moral values, infusion of exposure to ethics into clinical education not just for specific problem-solving purposes but also to humanize the ethos of care, and persuasion of institutional providers to create a section on ethical concerns in every patient record.
This book is not intended to be a practical aid for applied clinical ethics (disparaged as "thin" ethics). Rather, Tauber lays out a detailed exegesis of the philosophical principles underlying his view of the shortcomings and the amelioration of modern medicine. The resulting book is impressively referenced and written and is an intellectually elegant exercise in moral philosophy. However, it is written self-consciously in a language and style that will make it far more accessible to, and appropriate for study by, an audience of serious academic philosophers than one of practicing physicians.
Marshall B. Kapp, J.D., M.P.H.
Southern Illinois University School of Law
Carbondale, IL 62901
kapp@siu.edu((Basic Bioethics.) By Alf)