Social science & medicine
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Social science & medicine · Jan 1982
The basis of privacy and autonomy in medical practice. A model.
Most of the medical literature concerned with privacy seems to be based on the implicit assumptions that there is such a thing as right-to-privacy and that privacy is a worthwhile end unto itself. This paper develops a model which should permit a better and more pragmatic understanding of the moral, ethical and psychosocial bases of these assumptions. Arguments are offered that privacy is, indeed, not mainly an intrinsic value but is more of an instrumental value. ⋯ The model is developed which states: the analogy of a person is as a unit consisting of a matrix which is unique and autonomous because of its separation from other units by means of a wall-of-privacy; the relationship between persons is measured by their social distance. Derived from this is the 'equation', A approximately equal to (P)(D). Intimacy, substitutive judgement, confidentiality and patient-physician relationship are conceptualized within this model.
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Most economists have suggested that the growing presence of insurance, including Medicare, Medicaid, Blue Cross and the commercial insurers, is largely responsible for the rapid rise of health care costs in the United States. It is the contention of this paper, however, that the insurance industry in the private sector in the United States may help in the effort to contain costs rather than solely stimulating rapidly increasing costs. ⋯ It is cautioned, however, that although health insurer cost containment efforts will continue to expand in the future, perversities in the U. S. tax laws, potential provider opposition and the complexities of medicine will continue to make cost containment a difficult task.
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Social science & medicine · Jan 1982
Clinical Trial Historical ArticleHuman experimentation in historical and ethical perspectives.
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This paper examines the moral justification of medical paternalism. It is shown that while there are sufficient grounds to justify the practice of medical paternalism in some instances, there are many instances of the practice which cannot be justified. The application of the utilization principle of paternalism is considered in detail. ⋯ It is concluded that medical paternalism is justified only when utilitarian considerations apply and when they do not violate personal rights. This occurs only when the subject of paternalism is not fully competent, when he has explicitly or by implication given consent, or when it can be reasonably concluded, from the knowledge of his emotional and cognitive make up, that he would approve of such treatment. For the most part, only the physician with a more intimate knowledge of his patient than is possible in most modern medical practice is in the position to undertake medical paternalism with moral propriety.