Читать книгу The Wiley Blackwell Companion to Medical Sociology - Группа авторов - Страница 71

Among the factors leading to the success of the bioethics movement, briefly reviewed above, many are not specific to the American context. After all, the anti- authoritarian movements of the 1960s and the debates around the ends of science were not unique to American culture. In fact, outside the US, matters of research ethics and clinical ethics remain mostly separate; the general landscape is often one of a State-regulated field of research ethics, coexisting with a still silent world of clinical ethics in which medical discretion prevails. The accountability of the researcher and the physician to the human research subject has not so easily expanded to the ordinary patient in other countries. From a sociological perspective, the articulation between research ethics and bedside ethics remains the specific attribute and contribution of the American bioethics movement. In many countries, despite recent legal changes to promote patients’ rights, medical authority remains strong in the clinical context.

Among many of the factors that played a role in the coming of bioethics, the most salient to the American context is the importance of the law in formally promoting a lay voice in medical matters. Several authors (Annas 2004; Capron 1999) emphasize the crucial and “disproportionate influence” of American law in “shaping the content and methodology of the field.” There is in American society an implicit reliance on courts, a commitment to “due process,” and formal legal equality which translates “into an unwillingness to defer to expert authority” (Capron 1999: 296). California courts have been the most influential in shaping the doctrine of informed consent (Cobbs v. Grant, 502 P. 2d 1 (Cal 1972). Law played a crucial role in end of life issues, in the recognition of advance directives, and the right to refuse treatment. In Wolf’s (2004) terms, law and medical ethics have been constructing as a “co-production” the field of American bioethics. Another feature of bioethics in the US is the public visibility given by the different cases that have shaped issues normally kept into the private world of doctor-patient relationship. Cases such as Florida’s Schiavo case (2005) trigger media uproar and debates, that in turn sharpen thinking, helping define stakes, and allowing for mediation and a practical solution, vitalizing the public bioethical debate (Anspach 2010).

The autonomy paradigm is indeed an ethnocentric product; other cultural references may be more suitable to different healthcare systems, especially if these claim to be more oriented towards the “common good” than individual welfare. Not surprisingly, a stronger focus on vulnerability, dignity (Feuillet-Liger and Orfali 2018), and solidarity developed in the bioethics discourse outside the Anglo-Saxon world, particularly in cultures with socialized healthcare systems.