Abstract
Even T. Beauchamp and J. Childress, the founders of ethical principlism, noted that in practice the principles of bioethics, which they might have formulated, may conflict, and adherence to one principle may violate the other. To date, the conflict between the principle of autonomy and the doctrine of informed consent, and the principle of vulnerability formulated ten years later (one of the principles introduced by P. Kemp) and the necessity to take care of the patient is one of the major irreconcilable conflicts. This conflict is especially severe in Russia, where the informed consent was immediately enshrined as a statutory provision without prior discussion with the medical and non-medical communities, which gave rise to numerous opportunities for misuse and abuse, and stepped up the bureaucratic pressure both on patients, who became more vulnerable, and the physicians, who started using the informed consent to their advantage, sometimes being openly market-oriented. The growth of mutual mistrust, sometimes reaching the level of aggression, forces one to find a remedy for this situation. In the author's view, this requires revision of the patient’s autonomy concept and the concept of informed consent considering the acceptance of the patient’s intense vulnerability and the patient’s need for the healthcare specialists’ (physicians and nurses) personal involvement and care. It may be helpful to consult the writings of the ethics of care, feminist ethics and other ethical trends representation, as well as the results of field research aimed to combine principles of freedom and patient care in a given situation.
Highlights
As a lecturer in bioethics, the author has an opportunity to ask the trainees, i.e., students, postgraduate students, physicians and nurses, about their interpretation of the informed consent rationale: whose rights are protected by this process? The vast majority give an emphatic response without hesitation: the interests of physician. They explain: the patients should be responsible for their decisions, the physician is not a nanny for his patient, etc. It seems that many modern physicians sort of forgot, or, may be, did not even know, that the informed consent was set up to protect the patient against high-handedness of the medical specialists and was considered the greatest achievement for the protection of human rights
Article 34 permitted providing medical care without the consent “in cases of patients who suffer from contagious diseases and serious psychic disorders or for persons who have committed socially dangerous deeds on the grounds and in the order prescribed by the legislation of the Russian Federation”
It is worth emphasizing that this approach came in some ways as a surprise both for Russian physicians and Russian patients, and the further application of the practice of the informed consent in our country resulted neither from the patients’ perceived need for autonomy, nor from the physicians’ understanding of their responsibility for implementation of this patient’s right
Summary
It seems that many modern physicians sort of forgot, or, may be, did not even know, that the informed consent was set up to protect the patient against high-handedness of the medical specialists and was considered the greatest achievement for the protection of human rights. Later the informed consent formed the basis of the American bioethical principlism declaring respect for the rights and freedoms of the patient.
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