Biomedical Engineering Reference
In-Depth Information
the ethical status of end-users of their products becomes more complex.
7
This
is due not to technology users being exceptional or idiosyncratic but because
of conflict in the current characterization of service receivers in the health
care system.
On the one hand, the traditional portrayal of patients in medicine has
been as unknowledgeable dependents who ought to be compliant with the
expert decisions of physicians for their own good. On the other hand, courts
adjudicating cases in which patients have not been benefitted but instead
harmed, and legislators enacting statutes to prevent more such cases, have
conceived of patients as autonomous agents who typically are competent
to consent to risk for the sake of benefit (or to refrain from consenting)
if only they are given appropriate information. The medical professionals'
obligation to obtain patients' informed consent is grounded in this recently
expanded notion of the doctor-patient relationship as like a contract between
two individuals with equivalently respectable agency.
The development of codes or schemes of, or philosophical approaches to,
professional ethics in medicine and related fields - endeavors that conduct
medical research on human subjects or provide therapeutic or other health
care services to them - became of increasing concern during the last half of
the twentieth century. This effort responded to a deepening erosion of trust
in medical professionals, fueled at least in part by the 1946-1947 trial of
the Nazi doctors who sterilized, euthanized, and experimented on patients.
Revelations about scandalous conduct toward patients entrusted to physi-
cians' care exacerbated the evaporation of confidence in physicians giving
the individual patients' good priority over other values that may drive them.
Investigations at Tuskegee, Willowbrook, and other venues revealed that the
health of patients whose welfare was placed in the hands of physicians had
instead been sacrificed by those same physicians, who invoked the value of
advancing scientific knowledge to defend their actions.
Restraints on professionals in whom the well-being of vulnerable patients
was vested needed to be inherent in the healthcare professions themselves,
or else the state would intervene in the forms of regulative legislation or
restrictive case law. Codes of professional ethics partly staved off regulation
through law. Nevertheless, this was a time of unprecedented statutory and
judicial action aimed at protecting patients by emphasizing their right to
determine whether to accept medical interventions.
Being subject to regulatory law, and to civil rights protections for pa-
tients, altered the conceptual framework of medicine. In the courts at least,
if not as clearly and consistently in the clinic, patients no longer were con-
ceptualized as passive and clueless beings dependent on the benevolence of
healthcare professionals but were thought of, instead, as (usually) competent
choosers with the right to control what is done to their bodies and their minds.
7
The descriptions in this section are familiar ones in the literature of medical ethics. For
expanded discussion of them, see such standard textbooks as [
1
,
14
,
7
].
