Available in Russian
Author: Alexandra Troitskaya
DOI: 10.21128/1812-7126-2024-1-25-39
Keywords: medical care; bioethics; paternalism; personal autonomy; informed consent
The article presents a discussion regarding two key principles of the interaction between doctors and patients – paternalism and freedom of personal choice, proposed, respectively, by traditional medical ethics and by bioethics. The effect of these principles is traced in the history of medical relations in Russia, in both its ethical and legal components. The stability of paternalistic ideas is shown, with not only subjective, but also objective (relating to the distribution of competencies) reasons for this. At the junction between these principles, a “middle path” is proposed – the principle of providing respectful assistance. To substantiate it, based on the positions of I.Kant and modern research, the category of patient autonomy is clarified and directions for creating guarantees of it are proposed, addressing issues of the (in)adequacy of existing standards for the time of patient appointments, the need to develop communicative scenarios for the interaction of medical and other personnel of medical institutions with patients, supplementing school educational programs, and forming among a wide range of people ideas about health care and the principles of providing medical care. These proposals are a way to ensure that the institution of informed consent, which in Russia is designed to reflect the principle of autonomy of the will of a patient, functions in accordance with its original purpose. In addition, the proposals are aimed at increasing the level of compliance in patients’ behavior while receiving competent treatment, corresponding to the objectives of the healthcare system. From a theoretical point of view, a change is called for in the perception of the concept of patient autonomy, which requires not just non-interference in making competent decisions but also additional governmental efforts. Theoretical considerations are supplemented by a demonstration of their application in practice, the need for which is not obvious despite its simplicity.
About the author: Alexandra Troitskaya – Doctor Habilitatus (Dr. habil.) in Law, Professor of the Constitutional and Municipal Law Department, Faculty of Law, Lomonosov Moscow State University, Moscow.
Citation: Troitskaya A. (2024) Avtonomiya lichnosti kak printsip okazaniya meditsinskoy pomoshchi: mezdu paternalizmom i (mnimoy) svobodoy vybora [Personal autonomy as a principle of medical care: between paternalism and (imaginary) freedom of choice]. Sravnitel’noe konstitutsionnoe obozrenie, vol. 33, no. 1, pp. 25–39. (In Russian).
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