Who Decides? Informed Consent for Cancer Patients in Mexico
Studies have shown that the western values behind the principle of patient autonomy cannot be applied in a universal manner. In many countries, the principle of autonomy is applied by involving the family in decision-making. Families receive information a
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Who Decides? Informed Consent for Cancer Patients in Mexico Alonso Cerda´n, Alejandro Gonza´lez-Arreola, and Emma Vera´stegui
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Introduction
The Anglo-American model of applied ethics, notably as presented by L. Beauchamp and James F. Childress (2009), has dominated international bioethics. Many ethicists argue that there are fundamental ethical principles which should apply across all cultures and all nations, but the emphasis given to patient autonomy and informed consent (two fundamental ethical principles) can seem very peculiar for many other cultures. According to the American Medical Association (2008), informed consent is: . . . a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention
The College of Physicians and Surgeons of the Canadian province of Alberta (2002) considers that a patient competent to give consent (Grubb et al. 2003:89): . . . if [the patient] is capable of understanding what is involved in the medical treatment, including the procedure itself, its consequences and the consequences of non-treatment
Several studies have shown that the western values behind the principle of patient autonomy cannot necessarily be applied in a universal manner (Blackhall et al. 2002). Young (2001) describes the western principle of autonomy as demanding self-determination, assuming an individual subjective conception of the good, A. Cerda´n (*) Project Director of GESOC and Young Leaders Scholarship Recipient of the World Bank, GESOC A.C., Mexico DF, Mexico e-mail: [email protected] A. Gonza´lez-Arreola Director of GESOC, Mexico DF, Mexico E. Vera´stegui Palliative Care, Senior Attending Physician, Instituto Nacional de Cancerologia, Mexico DF, Mexico N. Homedes and A. Ugalde (eds.), Clinical Trials in Latin America: Where Ethics and Business Clash, Research Ethics Forum 2, DOI 10.1007/978-3-319-01363-3_11, © Springer International Publishing Switzerland 2014
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and promoting the value of individual independence, and Blackhall et al. (2001:59) makes the point that: Ethnicity was the primary factor related to attitudes towards truth telling and patient decision making. In many countries, the principal of autonomy is applied by involving the family in decision-making (Fan 1997). In this process of collective decision-making, families receive information about the patient’s diagnosis and make the treatment decision, often without consultation with the patient who, for cultural reasons, has not been told the diagnosis. In Mexico, the right to health was established in the Constitution, although, in the fragmented Mexican health system, half of the country’s poorest people do not belong to the Social Security system. Many of them are instead affiliated with the Popular Insurance program (Seguro Popular), which leaves them with uncertain access to health services and some medications. Informed consent is an ethical obligation and a legal requirement specified in the Mexican Health
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