GESTIÓN EN SALUD PÚBLICA: BioEdge: Trust me, I’m a doctor

sábado, 4 de marzo de 2017

BioEdge: Trust me, I’m a doctor

Trust me, I’m a doctor

by Michael Cook | 4 Mar 2017 |

Ever since the Enlightenment, unbelievers have rubbished the notion of trusting faith as grounds for belief. “Faith is the great cop-out, the great excuse to evade the need to think and evaluate evidence. Faith is belief in spite of, even perhaps because of, the lack of evidence.” Such is the view of evolutionary biologist Richard Dawkins on the topic of informed consent to Christianity.

However, as everyone who has ever been asked to sign a consent form appreciates, faith without evaluating the evidence is an everyday experience in medicine. So, is consent based on trust morally inferior to consent based on empirically verifiable information? Two Danish researcher argue in the journal Bioethics that is it not. “Under appropriate conditions, trust-based consent is not morally inferior to informed consent,” they write. “Consent based on trust has the potential to realize all four underlying moral concerns – autonomy, voluntariness, non-manipulation, non-exploitation – to (at least) the same degree that consent based on information does.”

In particular, consent based on trust, they contend, is consistent with a patient’s autonomy.

we often base decisions about our actions – even ones that may affect our well-being – on our trust in the agents proposing them, and less on information about what they entail. This type of decision-making is not typically considered to be imprudent or irresponsible on behalf of the agent (under proper circumstances), and it would not be unreasonable for the agent to generally expect good consequences as a result of this type of decision-making. We believe that these observations are equally applicable to the decision to participate in medical research. Based on the assumption that two situations that share the same relevant features should receive the same normative evaluation, under proper circumstances, trust-based consent to medical research is no less prudent than consent based on information.

Naturally, as they point out clearly, trust is only morally acceptable if the person (or institution) has been shown to be trustworthy.

Parramatta is just 20 minutes west of the BioEdge office. It’s not a city which has made a huge mark on the world, although not long ago an ISIS-inspired teenager shot dead a police employee and ended up dead himself. It has a lot of historic buildings from the colonial era, surrounded by high rise office buildings, drab shops and a huge park.

A few weeks ago the park hosted Tropfest, billed as the world’s largest short film festival. The crowds watched the films on huge screens as they picnicked on the grass. I was amazed that the winner was a 7-minute film about euthanasia, “The Mother Situation”. With excellent acting and snappy dialogue, it is a brilliant black comedy. Three adult children are delighted to hear that their mother wants to be euthanised – but then she changes her mind.

The director, Matt Day, says that it is not an anti-euthanasia film, but I haven’t seen anything which illustrates more vividly the danger of elder abuse. Sure, it’s absurd and a bit unrealistic but it sends a powerful message. Check it out.