The Passive Patient: Culture of Disrespect in Law and Medicine

Supriya Subramani, Postdoctoral Fellow (ESKAS Scholar) at the Institute of Biomedical Ethics and History of Medicine, is writing a monograph on the culture of disrespect in law and medicine for Routledge. 

One of the underlying assumptions of bioethics and healthcare debates in the age of ‘new medicine’ is that the patient is an active agent: a capable and competent adult who can make autonomous decisions, overthrowing the long-held notion and practice of ‘doctor knows best’. In most developed countries, this pro-patient approach that emphasizes patient autonomy and self-determination has been adopted in both ethical analysis and legal doctrines. Given the growing presence of medical ethics debates in the developing world, the pro-patient approach has become central to both clinical ethics guidelines and legal doctrines in these socioeconomic cultural contexts. Though the exportation of certain bioethical concepts to developing countries mirrors the globalization of biomedicine, it does have challenges arising from local social and moral worlds, structural issues and assumptions, and expectations of the doctor-patient relationship. Thus there exists a gap in theory and practice. This book aims to understand and bridge the gap existing between theory and practice, and explores the underlying archetype of a patient in law and clinical practice in the Indian context. This work is motivated by the need to understand the archetype of a patient in institutions like law and medicine which has not been thoroughly examined in global ethics and health research literature, and to thereby critically engage with both theoretical and practical debates of patient-centered care and the persistent asymmetry in healthcare interactions and inequities in hospital settings in developing countries, such as India. This book will not only appeal to scholars working on ethical concepts and health research in developing countries, but even attract scholars from developed countries as it helps in understanding the process behind the persistence of inequities in doctor-patient interactions and disrespectful attitudes and practices in this age of ‘new medicine’.

Giovanni Spitale