GESTIÓN EN SALUD PÚBLICA: BioEdge: A dissenting view of modern bioethics

domingo, 17 de junio de 2018

BioEdge: A dissenting view of modern bioethics

BioEdge: A dissenting view of modern bioethics

Bioedge

A dissenting view of modern bioethics

by Michael Cook | 16 Jun 2018 |

Today, your doctor is likely to be a "stranger at the bedside," making decisions according to a "new morality" of bioethics, rather than the traditional Oath of Hippocrates, writes Dr Jeffrey Hall Dobken in the Journal of American Physicians and Surgeons. Dr Dobken writes from the perspective of a doctor who is also a patient with a terminal disease. It is a stinging – and rare – attack on conventional bioethical principles.

Framing ethical questions has passed from the physician to the bioethicist, who may have no medical training, Dobken writes. Bioethicists may be moral philosophers, theologians, clergy, attorneys, hospital administrators, nurses, therapists, or others, with academic degrees in law, business, economics, health policy and management, public health, social science, political science, or allied health sciences such as pharmacology or nursing.

The foundational questions are: Whose needs are being served, or whose interests are being protected? In traditional Hippocratic ethics, the goal is to serve the patient. Bioethics places society or the "system" first, Dobken contends.

The four core principles of bioethics—replacing the supposedly outmoded Oath of Hippocrates—are patient autonomy, provider beneficence (doing "good"), provider non-maleficence (doing no harm), and justice (treating equal cases equally). Bioethicists consider themselves the guardians of social justice, Dobken states. The code they are expected to follow leads to predictable and stereotypical results. Physicians are marginalized, and individual autonomy in patient decision-making has been effectively negated.

Bioethicists, Dobken writes, "have, in large measure, enabled the transition from Hippocratic ethics to post-modern bioethics," which enables "healthcare reform." Bioethics emphasizes "a gatekeeper duty…focused on community resources and distribution of sparse resources in an economic view based on a social justice ideology."

"These goals appeal to the healthy well, and thus are readily saleable to society, including the 'new class of medical professionals,'" Dobken observes. But what about the sick patient?

"Bioethics represents a radical shift in focus away from the individual to the collective," he concludes. "The implications for patient care deserve sharp scrutiny, not blind acceptance of bioethical premises based on prestige and proclaimed lofty intentions."

Sunday, June 17, 2018

The Economist recently highlighted growing concern about “the surveillance state”. It argued that “the digital world, like the real one, [should have] places where law-abiding people can enjoy privacy. Citizens of liberal democracies do not expect to be frisked without good cause, or have their homes searched without a warrant.”

And it concluded, “Police rightly watch citizens to keep them safe. Citizens must watch the police to remain free.”

This is useful advice for anyone sending DNA to a genealogy website. Our lead story below is an example of how police vigilance, open source data, and personal privacy become scrambled. Earlier this year California police used the DNA of a vicious serial killer who had been off the radar for more than 30 years and identified him through a popular website.

I can imagine that some users must have been outraged. This could happen to me: what gives police the right to trawl through my relatives? Perhaps we should follow the advice of The Economist and require warrants for searching family trees on the internet.

On another note, you probably know that we're coming to the end of our fund-raising drive. Please think about a donation -- BioEdge has no sugar daddy, no big institution, behind it. We depend on the generosity of our readers for survival.