Year: 1981
Type: book-review
Abstract: This recent treatise in the sociology of medicine combines social science data and a normative message.Of interest is the way that a sociologist sets up the problem of informed consent.Barber views the issue of informed consent as a soc ial problem -that is, as a social condition which a sizable group recognizes as bad, unnecessary, and remediable.Social problems typically involve value conflicts and associated power conflicts between two or more groups.The specific social problem in question is the use of research subjects without their voluntary and informed consent.Barber identifies the conflicting values as those which physicians place on their own autonomy and authority and the value which the public attaches to equality in the physician-patient relationship.Barber has in mind moral equality, which he says is the same as the value we place on human dignity."When we speak of the moral claims of human dignity , we say that each individual in and of himself deserves to be treated in a certain way , with respect and protectiveness ...The task which Barber sets for himself is to provide a "social systems analysis" of informed consent.According to Barber, in order to understand the nature of this social problem we have to examine the entire social system in which doctors and patients interact.The system of health care delivery produces roles, attitudes, and ex pectations which affect the values and behavior of physicians and patients.Barber's systems analysis consists of examining the literature on each of the following factors which influence the relations among the various participants in the medical research system: relevant moral values and norms, legal principles and rules concerning informed consent, the communication structures and patterns of understanding and misunderstanding, the authority relations, and the mechanisms of informal and formal social control.Informal control refers to interactions which influence one's moral attitudes and which occur in everyday working relationships among physicians or between physicians and patients.Formal control refers to official structures which influenc e ethical behavior, such as state licensing boards or IRB's.. After examining the above factors , Barber reaches the normative conclusion that physicians are too au thoritarian and do not adequately inform their patients.In the process he argues that there is little informal control with respect to ethics in me dical education and among practicing physicians.He also argues that there are serious defects in present mechanisms of formal control.With respect to hospita l review committees, for example, h e cites a study which claims that most moral lapses by physicians which are reviewed are swept under the carpet.He concludes that formal controls need to be improved, "though probably the primary improvement must occur in the informal mechanisms."All in all, there is relatively li ttle in this book which has not been said before.Barber's original contribution is to attempt to marshal all the social science data
Author: Carson Strong
Language: English
Field: Medicine
Domain: Health Sciences
SDG: Reduced inequalities
Open Access status: green
OpenAlex ID: W2573402365