The doctrine of informed consent, defined as respect for autonomy, is the tool used to govern the relationship between physicians and patients. Its framework relies on rights and duties that mark these relationships. The main purpose of informed consent is to promote human rights and dignity. Some researchers claim that informed consent has successfully replaced patients' historical predispositions to accept physicians' advice without much explicit resistance. Although the doctrine of informed consent promotes ideals worth pursuing, a successful implementation of these (...) ideals in practice has yet to occur. What has happened in practice is that attorneys, physicians, and hospital administrators often use consent forms mainly to protect physicians and medical facilities from liability. Consequently, ethicists, legal theorists, and physicians need to do much more to explain how human rights and human dignity relate to the practice of medicine and how the professionals can promote them in practice. This is especially important because patients' vulnerability has increased just as the complexity and power of medical science and technology have increased. Certain health care practices can shed light on the difficulties of implementing the doctrine of informed consent and explain why it is insufficient to protect patients' rights and dignity. Defining a normal biological event as a disease, and routinely prescribing hormone drug therapy to menopausal women for all health conditions related to menopause, does not meet the standards of free informed consent. Clinicians provide insufficient disclosure about risks related to long-term use of hormone therapies and about the absence of solid evidence to support their bias toward hormone therapies as a treatment of choice for menopause related health conditions. The contributing problem is women's failure to act as autonomous agents because they either choose not to take an active part in their own therapy or because they fear to question physicians' medical authority. To insure that patients' autonomy and free choice are a part of every physician-patient interaction, physicians and patients need actively to promote them as values that are absolutely indispensable in physicians' offices, clinics, and hospitals. (shrink)

This article analyses and discusses research-ethical dilemmas, ambivalences and problematic issues. This is done firstly by making a distinction between procedural research ethics and particularistic research ethics. Such a distinction refl ects a theoretical construction and generalization – in practice there can be a very close correlation between the two types. Hereafter, the distinction will therefore be used as a jumping-off point for the presentation of a pragmatic-dualist research ethics. Th e approach is dualist because it draws on the presence (...) of two independent, contrasting understandings, which are essentially diff erent yet equal aspects of good research ethics; and it is pragmatic because this dualism is first and foremost structural and institutional by nature, and designed with an eye to what can realistically and expediently be done in practice. Thus the intention of the article is to both analyze and discuss two different understandings of research ethics and simultaneouslyqualify a research ethics that draws on both these understandings. At the same time, the intention is to try to visualize a diff erent understanding of research ethics which others can address and elaborate on or qualify but even at this point can be included in an arsenal or catalogue of research-ethical understandings and approaches that can be exploited in research-ethical practice. (shrink)