Advertisement

Central European Journal of Medicine

, Volume 3, Issue 2, pp 141–148 | Cite as

An open future? The principle of autonomy within medical ‘codes of conduct’ versus the heteronomy effects of predictive medicine

  • Ignaas Devisch
Review Article
  • 70 Downloads

Abstract

Traditionally, the average code of conduct within Western health care starts from the autonomy of the patient. In addition, medicine today is ‘evidence based’ and the patient is an ‘informed consent’. Yet, the individual autonomy of the patient in health care is not simply enhancing today. Quite a few fundamental changes have and are currently at work within health care, which I will summarize here with the paradigm of predictive medicine. One of the characteristics of this paradigm is the increase of medical consults which are not autonomously chosen by an individual. For reasons of public health and diminishing of health risks or for reasons of prevention, on one hand we are dealing with ethical codes centered around the autonomy of patients and the face-to-face relations with health care workers, on the other, we are dealing with a society that takes an increasingly greater medical initiatives. Therefore, the question arises if predictive medicine confronts us with the limits of an ethical code as we know it today. Is there not an urgent need for a political code of conduct in health care?

Keywords

Predictive medicine Autonomy Code of conduct Heteronomy Ethical Political 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    De Vries G., Voorspellende geneeskunde. Ethische en politiek-filosofische problemen rond een nieuw paradigma, Ethische perspectieven, 1999, 9, 183–197CrossRefGoogle Scholar
  2. [2]
    King J.S., Moulton B.W., Rethinking Informed Consent: The Case for Shared Medical Decision-Making, American Journal of Law & Medicine, 2006, 32, 429–502Google Scholar
  3. [3]
    Hedayat K.M., The possibility of a universal declaration of biomedical ethics, Journal of Medical Ethics, 2007, 33, 17–20PubMedCrossRefGoogle Scholar
  4. [4]
    Beauchamp C., Principles of biomedical ethics, Oxford, Oxford University Press, 2001, 454; Huibers A.K. and Spijker A., The autonomy paradox: predictive genetic testing and autonomy: three essential problems, Patient Education and Counseling, 1998, 35, 53–62Google Scholar
  5. [5]
    Oliffe J., Thorne S., Hislop T., Gregory Msc, Armstrong E.A., ’Truth Telling’ and Cultural Assumptions in an Era of Informed Consent, Family & Community Health, 2007, 30, 5–15Google Scholar
  6. [6]
    The ‘ethics in medicine’ from the University of Washington School of Medicine’ (http://depts.washington.edu/bioethx/topics/consent.html); see also Beauchamp C., Principles of biomedical ethics, Oxford, Oxford University Press, 2001, 79
  7. [7]
    See King J.S., Moulton B.W., Rethinking Informed Consent: The Case for Shared Medical Decision-Making, American Journal of Law & Medicine, 2006, 32, 429–502Google Scholar
  8. [8]
    Beauchamp C., Principles of biomedical ethics, Oxford, Oxford University Press, 2001, 454Google Scholar
  9. [9]
    Horstman K., De Vries G.H., Haveman O., Gezondheidspolitiek in een risicocultuur: burgerschap in het tijdperk van de voorspellende geneeskunde, Den Haag, Rathenau Instituut, 1999, 106–107Google Scholar
  10. [10]
    Kruijf A.F., Schroeder R.F., Toekomstscenario’s voorspellende geneeskunde, Den Haag, Rathenau, 1999, 144Google Scholar
  11. [11]
    Nestle M., Food politics. How the food industry influences nutrition and health, Berkeley, University of California Press, 2002Google Scholar
  12. [12]
    Kruijf A.F., Schroeder R.F., Toekomstscenario’s voorspellende geneeskunde, Den Haag, Rathenau, 1999, 143Google Scholar
  13. [13]
    ’Trim u fit’ (1967), ’sportreal’ (1976), ’sport, zelfs ik doe het’ (1988) ‘Flash’ (2005). This list is only a selection; for further information see: http://www.minvws.nl/dossiers/sport/default.asp)
  14. [14]
    Di Pietro M.L., Giuli A., Spagnolo A.G., Ethical implications of predictive DNA testing for hereditary breast cancer, Annals of Oncology, 2004, 15, i65–i70PubMedCrossRefGoogle Scholar
  15. [15]
    Di Pietro M.L., Giuli A., Spagnolo A.G., Ethical implications of predictive DNA testing for hereditary breast cancer, Annals of Oncology, 2004, 15, i65–i70PubMedCrossRefGoogle Scholar
  16. [16]
    Kruijf A.F., Schroeder R.F., Toekomstscenario’s voorspellende geneeskunde, Den Haag, Rathenau, 1999, 147Google Scholar
  17. [17]
    ’Preventive maintenance for the human body’, brochure of The Institute for Predictive medicine’: http://www.predictivemedicine.us
  18. [18]
    Horstman K., De Vries G.H., Haveman O., Gezondheidspolitiek in een risicocultuur: burgerschap in het tijdperk van de voorspellende geneeskunde, Den Haag, Rathenau Instituut, 1999, 36Google Scholar
  19. [19]
    Kruijf A.F., Schroeder R.F., Toekomstscenario’s voorspellende geneeskunde, Den Haag, Rathenau, 1999, 147Google Scholar
  20. [20]
    Macintyre A., Whose justice, which rationality?, Indiana, University of Notre Dame Press, 1988Google Scholar
  21. [21]
    Beckman L., Are Genetic Self-Tests Dangerous? Assessing the Commercialization of Genetic Testing in Terms of Personal Autonomy, Theoretical Medicine and Bioethics, 2004, 25, 387–398PubMedCrossRefGoogle Scholar
  22. [22]
    Rogowski W., Current impact of gene technology on healthcare: A map of economic assessments, Health Policy, 2007, 80, 340–357PubMedCrossRefGoogle Scholar
  23. [23]
    “Zum Fragen gehört außer dem Gefragten ein Befragtes. In der untersuchenden, d.h. spezifisch theoretischen Frage soll das Gefragte bestimmt und zu Begriff gebracht werden. Im Gefragten liegt dann als das eigentlich Intendierte das Erfragte, das, wobei das Fragen ins Ziel kommt. […] Das Eigentümliche dieser liegt darin, daß das Fragen sich zuvor nach all den genannten konstitutiven Charakteren der Frage selbst durchsichtig wird” (Heidegger M., Sein und Zeit, Tübingen, Max Niemayer Verlag, 1993, 5Google Scholar
  24. [24]
    The World Medical Association Statement on Genetics and Medicine. Adopted by the WMA General Assembly, Santiago 2005: http://www.wma.net/e/policy/g11.htm
  25. [25]
    Beauchamp B.(eds), New ethics for the public’s health, Oxford, Oxford University Press, 1999, 344Google Scholar
  26. [26]
    Kruijf A.F., Schroeder R.F., Toekomstscenario’s voorspellende geneeskunde, Den Haag, Rathenau, 1999, 121 (my translation)Google Scholar
  27. [27]
    Henn W., Schindelhauer-Deutscher H., Kommunikation genetischer Risiken aus der Sicht der humangenetischen Beratung: Erfordernisse und Probleme, Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 2007, 50, 174–180PubMedCrossRefGoogle Scholar
  28. [28]
    Summers C., Realities of decision-making and social issues: Implications for developing and implementing ethics guidelines, Science of The Total Environment, 1996, 184, 17–23CrossRefGoogle Scholar
  29. [29]
    Gaunt N., Practical approaches to creating a security culture, International Journal of Medical Informatics, 2000, 60, 151–157PubMedCrossRefGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2008

Authors and Affiliations

  1. 1.Rehabilitation Sciences and Physiotherapy GhentBE-GhentBelgium

Personalised recommendations