Without Your Consent

When we get done restructuring American health care, will there still be doctors and patients? You have been drafted into a dangerous medical experiment with extreme risks to the individual, the medical profession and to society. We must balance the benefits and costs of health care in a way that protects both patient and doctor. Instead of confronting our health cost problems, we use the doctor to hide unavoidable trade-offs. Our aging population and the demand for medical technology send expenses through the roof and hurt American competitiveness. Millions remain uninsured. Meanwhile, we oppose any combination of insurance or legal reform, limits on profits or new taxation that could help deal with the problem. We recoil at the mere mention of the word "rationing. Yet we do ration. But this rationing remains unseen, hidden by the physician who has become a double agent, serving both the patient and the cost control needs of society. The insurers, the government and the hospitals have put the doctor in this position. And each uses the compromised doctor to further their own agenda. As this pattern becomes ingrained, medicine ceases to be a profession. And patients, unable to fully understand and thus consent to care, have lost their place as specially protected individuals. Without Your Consent examines these problems as a case study in the fascinating field of medical ethics. Trust, the bedrock of the patient-doctor relationship, demands full disclosure of the truth. I look at truth telling from multiple vantages; the philosophical roots, medical oaths, professional codes of behavior, ethics opinion, and laws regarding informed consent. I argue that none of these can override the doctors' need to survive, leaving her vulnerable to manipulation in a deeply hostile environment. We will need the truly professional physician more, not less, as the technologic revolution picks up speed. Physicians' ability to help, and harm, will grow exponentially. Privacy issues will become paramount. The patient will need a trusting relationship more than ever. I offer a model for openness and disclosure, and frame suggestions for saving honest medical care within the current political landscape. The usual liberal-conservative polarization obstructs resolution; measures from both end of the political spectrum will be needed. We can come to see the practical reality of our common need for a community of health.