Economic, Political and Clinical Autonomy - Essay Example

QUESTION The key aspect of medical dominance is professional autonomy, which is evidenced in three main ways: economic, political and clinical autonomy. Briefly outline any challenges by allied health professions to each of these aspects of medicine’s professional autonomy. How effective do you think the challenges you have identified have on them? ANSWER: Physicians’ professional autonomy is attributed to several levels. There is the collective autonomy, which pertains to the collective effort and control of the profession in setting the standards of entry as well as the conditions and terms of work (Stoddard et al, 2001). On the other hand, there is the individual autonomy. The individual professional autonomy of the physician is not only limited to his/her ability in making clinical decisions and in securing the necessary medical services for patients but it also encompasses the autonomy in pertinent to control over one’s own work, which may include the structure and schedule of the work (Stoddard et al, 2001). In line with this, allied health professions have challenged medicine’s professional autonomy. Currently, physicians’ economic stature is challenged from two sides. One is the increasing income gap between the specialists and the general practitioners and the other is coming from the National Health Services, which now requires doctors to produce job plans for the working week, the presence of preauthorization requirements, reducing their freedom to refer and their employment contract being held by Health Authorities (Harrison & Ahmad, 2000). In the same regard, the political standing of medicine’s professional autonomy has been opposed by the inceptions of governmental guidelines, bodies and policies that allow stronger governmental regulations. This is perceptible in terms of clinical audits, and the creation of governmental bodies like the National Institute for Clinical Excellence (NICE), National Services Frameworks (NSF) and Commission for Health Improvement (CHI), which provide the guidelines and frameworks that, limits medicine’s professional autonomy (Harrison & Ahmad, 2000). Finally, the clinical autonomy of the physician is challenged by the following concept of patient at the centre of care, of the practise of team management of care, which works on the supposition that health care providers are all equally important in rendering health care services, and that clinical decisions ought to be substantiated and justified by external research findings (Harrison & Ahmad, 2000) These challenges are effective in limiting medicine’s professional autonomy. This is based on the following claims: first, physicians are no longer the locus of care but that the centrality of patient care has paved the way for the equal importance of all the members of the health team. Second, it has changed the practise into ‘scientific- bureaucratic medicine’. Scientific since it requires that all clinical decisions must be justified by research and bureaucratic because it has to follow ‘clinical guidelines’. Third, through the politicising of the profession (via governmental regulations and policies), the profession, which ought to be depoliticised ‘becomes an invisible medium for health rationing’ (Harrison & Ahmad, 2000:142). QUESTION 2 Who have access to a person’s gene information? Does your answer differ depending on the group concerned? Why or why not? If you had a gene chip, would you want to know what diseases you may be susceptible to, given that there may be no effective treatments or any certainty that you would develop the condition? What would be the likely social implications if such genetic information were widely available? If gene chips were available, who should be responsible for regulating them? ANSWER: The person who is the owner of the gene information should have access to the information as well as some of his/her doctors under certain regulations. My answer will not change regardless of the group concern. This position is taken because of the following reasons: first, respect for the autonomy of the person should be upheld at all times and access to information pertinent to one’s own person is a manifestation of that respect. Second, in the era of information, a limited number of persons should access information contained in the gene, in this case the person and some of his/her doctors in order to minimize the risk of unscrupulous use of the information. If I had a gene chip, I would like to know what diseases I might be susceptible to, even if there may be no effective treatments or any certainty that I would develop the condition. The gene information that I would get may help me in charting a lifestyle that would enable me to optimise the quality of my life and create measures that would not hasten the development of the disease. I also believe that such information would help me in valuing my life more since it is a concrete evidence of the fragility and limitedness of life; of my own mortality and of the reality that I have to make the best out what I have and enjoy life’s passing moments. If genetic information were widely available, the possible social implications include: 1. The creation of new social stratification base on the genes that one may possess may become a reality (Best & Kellner, 2001). 2. The definition of humanity being limited to one’s genetic information may become an actuality. 3. It may perpetuate the increasing divide between the rich and the poor since more often than not the rich have the access to this information whereas the poor have a limited or no access at all. 4. Genetic profiling may become a new form of discrimination. 5. Genetic information may become a new source of power or control since this information can be used in order to pursue one’s own personal gain. If gene chips were available, there should be a concerted effort among the government, private enterprises and the citizens in finding means and ways in order to regulate the information. The necessity for this ‘working together of the government, the private and the public sector’ is integral since gene information is vital information that can be used for and against the individual by other persons/institutions. In this regard, the responsibility for regulating it does not fall only on some individuals/ institutions but it is the responsibility of all the stakeholders of the gene information. REFERENCES: Best, S. & Kellner, D. (2001) The Postmodern Adventure. Science Technology, and Cultural Studies at the Third Millennium. New York and London: Guilford and Routledge. Harrison, S., & Ahmad, W. I. U. (2000) ‘Medical autonomy and the UK state 1975 to 2025’, Sociology, Vol. 34, No 1, 129 -146. Stoddard, J.J, Hargraves, L., Reed, M., & Vratil, A. (2001) ‘Managed care, professional autonomy and income: Effects on physician career satisfaction’, J Gen Intern Med, Vol. 16, 675 – 684. Read More