From the Irish Times, 13 September 2018:
“The report includes scathing criticism of the medical profession, with male dominance in the healthcare sector coming in for scrutiny as the affected women pointed out that most of the doctors behind the failures to disclose information to female patients were men.
“The point was made that many of the major controversies about maltreatment of patients or denial of reproductive rights in the Irish healthcare system have involved women being damaged,” says the report.
“Why does it always happen to women?” one woman said to the scoping inquiry. “I think there is a history of looking at women’s health services as being secondary,” said another.
(Disclaimer: these are merely my notes on the Baroness’s lecture, and therefore not necessarily an accurate summary of what was said. This version in the J Med Ethics of a symposium on the limits of informed consent may be more useful >>> click here)
The three traditional concerns of medical ethics described by a medic as referrals, confidentiality & billing! Enormous changes in medicine (technology, budgets, expectations) led to a rejection of self-regulation and calls for accountability. Important expression of the shift: David Rothman’s Strangers at the Bedside [link to review in Medical History]. A new era of thinking on ethics emerging in the 70s/80s saw a rejection of paternalism as a model for medical practice. The trap of professional capture: whereby the needs of the regulated inevitably win out over those of the public in any system developed by the professionals themselves.
Public accountability has taken over as a principle determining obligations (especially second order ones); an auditing process such that all stakeholders can be satisfied. However, problems arise in relation to patient consent: a almost “mindless” pursuit of anti-paternalism ideals. Patient consent is the goal of the consent procedures, but there are limitations: to protect against coercion, deception, manipulation etc.
Continue reading “Notes on Professor Onora O’Neill Swan lecture on Intelligent Accountablity”