| Abstract |
One of the most important issues that occupy concern the modern interdisciplinary sector of Bioethics is the relationship between the doctor and the patient. Medical ethics, as part of this widest sector has caused many questions/ a lot of discussions. Discussions that have as final aim to vindicate, the superior perhaps good that the social living offers, the protection of life via the health and at last the maintenance of a harmonious mental and physical situation that uncontradictably constitutes the spark for every possible human activity.
Since the ancient years of Hippocrates, fundamental concern of medical practice was considered to be the belief "better do good than harm". Fundamental objective of doctor was with his handlings to help the patient or at least not to cause to him even bigger damage than the already existing. The doctor elected himself as the “holder” of any decision, which was founded in the affair, that himself, because of his faculties and his crisis, is able to take decisions that promote the interest of the patient. The doctor, that is to say, is presupposed that he can determine and decide what is good for the patient. Based on the above reasoning, the doctor-patient relationship is characterized as paternalistic. Trying to explain what precisely we call paternalism, we would call it as the interjection in the freedom of action of a person justified from reasons that are related exclusively with the good, the happiness, the interests, and the needs which the person is forced for.
Nowadays, a time in which has risen the significance of freedom, via the autonomy as a personal choice, meaning just as a freedom of choice among possible alternative solutions, the medical practice has been inevitably reformed. One of the thorniest problems that rise in ball of the doctor-patient relationship is the informed consent. Henceforth, it has been established the right of the patient to have a complete briefing regarding the situation of his health, to know all the possible alternatives of treatment and their potential side effects, as well as to consent or to deny the proposed from the doctor treatment. Thus is revised in the frame of modern medical deontology the basic beginning of Hippocrates Oath, the doctor’s primacy in the medical decision.
The first thing we have to contemplate, when we talk about the doctor-patient relationship, is that we are talking about a very complex and sensitive relation. Surely, we cannot face it as a relationship of consumerism, that is to say, that the doctor offers
his services and the patient is the consumer. This way we would easily support that the informed consent can and must be applied, as we have two rational and capable persons.
In the doctor-patient bipolar, the doctor she is in a more advantageous place against the patient. The doctor is the one, who has the information, the knowledge and the experience against the uneasy and often terrorised patient, who is suddenly found to confront with the illness, which usually, limits his rational faculty. This supremacy of the doctor cannot in any case justify paternalism. The principle of acting for the good`, meaning the protection of patient s interests on behalf of the doctor, because he knows better his patient s needs so he can protect him, can t help it by itself. The interest is not always an objective criterion, as what it better concerns the patient, and only he has the moral, but also the constitutional right of self-determination.
The respect of the patient s personality imposes his briefing and his explicit consent. The doctor surely has the duty of briefing, as the current laws also impress it. We have to make clear that the legal frame, so much in Greece as internationally, places only the conditions in order to have informed consent. In other words they say that the patient has to be free, when he takes a decision and not to be forced by exterior factors to give his consent, and certainly to be informed from his doctor. What really the patient understands when he receives the information, and which factors influence his will, are subjects that cannot be estamplished by the legal frame.
In order that we speak a free and conscious choice of the patient, there has to exist communication and confidence between the doctor and the patient. The existence of confidence and communication between the two sides is necessary for the informed consent. The respect of patient s autonomy imposes the doctor to inform the patient, however, thinking at the same time the existing peculiar conditions. It is morally wrong to ask the patient to give his consent while having simply revealed an abundance of medical information, especially at a time that the patient is in a very difficult position because of his illness. The information must be the ones that the patient needs and this can be achieved through the doctor- patient communication.
The full informing constitutes an aspect of reality, meaning an essential piece, but is not enough by itself. It is also required the significance of autonomy, which creates and supports bonds of confidence, in order the informing activity to have some value. Confidence, in order to occur, something that has occurred before with family doctors, now there has to be autonomy under the Kant s point of view, that would set
values, that would bind, both the acting person and the others. But values whose application on behalf of the doctor takes into consideration the particular elements of each case, of each patient and places certain inviolable limits, which even the patient himself cannot exceed.
Autonomy, under this point of view, autonomy of values, as O‘Neill calls it, presupposes the benefit of satisfactory and comprehensible information for the patients that have the capability to make a rational choice for the medical interventions that will be made to them. And they do this responsibly and also thinking about the others. I consider that this model in the doctor-patient relationship ill, in which there is a reciprocal agreement between the contracting parts and also there are duties and obligations for both sides, is the one that can give a solution in the problem of informed consent. Confidence from both sides is found in the heart of this relation.
Ιn the frame of this analysis, it emerges that the freedom of patient does not just stand for a negative right, that opposes to any imposition on behalf of the doctor in the patient even for the promotion of its medical good. It is also a positive right that dictates specific energies on behalf of the medical and nursing personnel, that concerns the widest time-place, social and psychological frame, inside which there are taken the patients decisions.
The doctor, according to the model of informed consent, which was presented in this study, does not decide, but just proposes. The decision belongs to the patient. Also, the consent, also, does not mainly the doctor’s opinion, but the implementation from the doctor of an action that realises this opinion. Provided that, for the materialisation of the action intervenes an intermediary institution, the doctor, and the patient cannot apply the medical action by himself, the consent for the particular action from to be executed by the doctor is essential and it mainly concerns this. The patient, in which is recognized the freedom, it decides under the model of autonomous consent, shapes his own opinion, which can also object to the one proposed by the doctor. The patient, that is to say, shapes his own opinion, makes a decision and agrees in the application of this action by the doctor.
Moreover, the help and not the determination, which the doctor offers through his proposal which addresses to the patient, based on his special knowledge and on his experience, is very important, in order the patient to feel free to decide. Otherwise, we will have to wonder if the hail of information concerning the human life with no further
engagement on behalf of the doctor, leave the person helpless, in a tragic freedom, in which he could feel weak to decide autonomously.
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Ιπποκρατικό μοντέλο ή ενήμερη συγκατάθεση; Τα όρια της ιατρικής ευθύνης
