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Ethics
Paper
Choice is not the issue. The misrepresentation of healthcare in bioethical discourse
  1. Kari Milch Agledahl1,
  2. Reidun Førde3,
  3. Åge Wifstad2
  1. 1Finnmark Hospital Trust, Norway
  2. 2Institute of Community Medicine, Faculty of Health Sciences, University of Tromsø, Norway
  3. 3Section for Medical Ethics, University of Oslo, Norway
  1. Correspondence to Kari Milch Agledahl, Finnmark Hospital Trust, Sykehusveien 35, 9613 Hammerfest, Norway; kari.agledahl{at}helse-finnmark.no

The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion.

  • Personal autonomy
  • bioethics
  • medical ethics
  • professional practice
  • delivery of healthcare
  • applied and professional ethics
  • philosophy of medicine
  • informed consent

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/jme.2010.039172

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    The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion.

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    Footnotes

    • Funding The Northern Norway Regional Health Authority, Helse Nord RHF, 8038 Bodø, Norway. Finnmark Hospital Trust, Helse Finnmark HF, Sykehusveien 35, 9615 Hammerfest, Norway.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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