Medicalization as a moral problem for preventive medicine

Bioethics

Volumn 13, Issue 2, 1999, Pages 89-113

  Verweij, Marcel ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONCEPT FORMATION; DECISION MAKING; HEALTH BEHAVIOR; HEALTH PROMOTION; HUMAN RIGHTS; IATROGENIC DISEASE; INTUITION; MORALITY; NORMAL HUMAN; PREVENTIVE MEDICINE; SOCIAL CONTROL; WELLBEING;

EID: 0032769365     PISSN: 02699702     EISSN: None     Source Type: Journal    
DOI: 10.1111/1467-8519.00135     Document Type: Article

References (37)

1. Department of Welfare, Health and Culture. Preventiebeleid voor de volksgezondheid. Praktische keuzen in de jaren negentig. Rijswijk, 1992; p. 5.
2. Zola, I.K. 'Medicine as an institution of social control', Sociological Review 20 1972; 487-504.
3. Conrad, P. 'Medicalization and social control', Annual Review of Sociology 18 1992; 209-232: 213.
4. Zola, I.K., op.cit., 490.
5. Conrad, P. op.cit., 213.
6. Iemhoff, W.G.J. 'Groei van kennis en beïnvloeding van gedrag', Tijdschrift voor Sociale Gezondheidszorg 63 1985; 483-488: 485.
7. Laeyendecker, L. 'Gezondheidsstreven: spiegel der cultuur', in: Dekker, E. and E. Elsinga (eds.), Mensen en machten. Gezondheidszorg in de jaren 90, Houten: Bohn Stafleu van Loghum, 1990, 13-14.
8. Zola, I.K., op.cit., 487. De Swaan, A. 'The reluctant imperialism of the medical profession', Social Science and Medicine 28 1989: 1168.
9. Zola, I.K., op.cit., 487. De Swaan, A. 'The reluctant imperialism of the medical profession', Social Science and Medicine 28 1989: 1168.
10. Conrad, P., op.cit., 223-224.
11. Department of Welfare, Health and Culture. Preventiebeleid voor de volksgezondheid. Praktische keuzen in de jaren negentig. Rijswijk, 1992: 5.
12. De Beaufort, I. 'Individuele autonomie, paternalisme en maatschappelijke verantwoordelijkheid', Tijdschrift voor Gezondheidsrecht 15 1991: 2-16.
13. Verweij, M.F. Ethiek van preventie. Zoetermeer: Nationale Raad voor de Volksgezondheid, 1992: 19.
14. Illich, I. Limits to medicine. Medical nemesis: the expropriation of health. Harmondsworth: Penguin, 1977: 11.
15. See, for example, Skrabanek, P. and J. McCormick, Follies and fallacies in medicine, Ravenstone: The Tarragon Press, 1992. Skrabanek, P. 'Why is preventive medicine exempted from ethical constraints?' Journal of Medical Ethics 16 1990:187-190. McCormick, J. 'Medical hubris and the public health: the ethical dimension', Journal of Clinical Epidemiology 49 1996: 619-621.
16. See, for example, Skrabanek, P. and J. McCormick, Follies and fallacies in medicine, Ravenstone: The Tarragon Press, 1992. Skrabanek, P. 'Why is preventive medicine exempted from ethical constraints?' Journal of Medical Ethics 16 1990:187-190. McCormick, J. 'Medical hubris and the public health: the ethical dimension', Journal of Clinical Epidemiology 49 1996: 619-621.
17. See, for example, Skrabanek, P. and J. McCormick, Follies and fallacies in medicine, Ravenstone: The Tarragon Press, 1992. Skrabanek, P. 'Why is preventive medicine exempted from ethical constraints?' Journal of Medical Ethics 16 1990:187-190. McCormick, J. 'Medical hubris and the public health: the ethical dimension', Journal of Clinical Epidemiology 49 1996: 619-621.
18. Not only knowledge of risks may undermine feelings of health and well-being, even awareness of one's health may have negative effects. 'Paying increased attention to one's body and one's health tends to make one assess them more negatively, with greater feelings of ill health. Several investigations have shown that bodily awareness, self-consciousness, and introspection are associated with a tendency to amplify somatic symptoms and to report being troubled by more symptoms'. Barsky, A.J. 'The paradox of health', New England Journal of Medicine 318 1988: p. 416.
19. Cf. Tijmstra, Tj. and C. Bajema, 'Je zult die ene maar zijn; risicobeleving en keuzegedrag rond medische technologie', Nederlands Tijdschrift voor Geneeskunde 134 1990, 1884-1885.
20. Wikler, D. 'Personal responsibility for illness', in: Vandeveer, D. and T. Regan, Health care ethics: an introduction, Philadelphia: Temple University Press, 1987; 326-358: p. 330.
21. Cf. Postema, G. 'Collective evils, harms and the law'. Ethics 97 1987:414-440, p. 421: 'States of affairs are collectively valued if one values them qua member of a given community, or insofar as one regards them from the point of view of a member of that community. . . . [W]hat makes these states valuable to me is (in part at least) that we value them, and that, in acting on them or planning and working for their realization, we not only aim at some common good, but we also manifest a civic spirit, express our solidarity.'
22. Cf. Dworkin, G. 'Voluntary health risks and public policy: Taking risks, assessing responsibility', Hastings Center Report 11 1981:26-31.
23. Cf. Crawford, R. 'You are dangerous to your health. The ideology and politics of victim blaming', International Journal of Health Services 7 1977:663-680.
24. D. Wikler, op.cit., 342.
25. I. Illich, op.cit., 86.
26. Cf. P. Ippel, 'Gezondheidsrecht en gezondheidsethiek', in: W. van der Burg and P.C. Ippel, De Siamese Tweeling, Assen: Van Gorcum, 1994.
27. The reasons for preferring 'respect for autonomy' above 'medicalization terms' for these considerations are similar as the reasons I gave in § 3 for stating considerations about risk and harm in terms of non-maleficence.
28. In curative medicine and health care, the growing dependence of patients on their doctors will probably result in a loss of possibilities of these persons to cope with their illnesses and complaints. This development is morally problematic insofar it is to the detriment of a person's well-being. There is an analogy with preventive medicine, which may cause a diminishment of a person's capacity to cope with uncertainty and risk (cf. § 4).
29. Prendiville, W., D. Elbourne and I. Chalmers, 'The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials'. British Journal of Obstetrics and Gynaecology 1988 95: 3-16.
30. Norman, R. 'Interfering with nature'. Journal of Applied Philosophy 1996 13: 1-11.
31. Still, the proposal of routine prescription of oxytocine by midwives can be criticised as a form of medicalization. But it is not so much the practice of birthgiving which is thereby labelled as a moral problem; the practice of midwifery (as distinguished from medical obstetrics) is becoming morally problematic. After all, the aim of non-medical midwifery is to facilitate natural birth and to make medical interventions unnecessary. The introduction of medical techniques into this practice infringes with its central goals.
32. Barsky, A.J., op.cit: 415.
33. Ten Have H.A.M.J.and G.M.W.R. de Wert, op.cit.:78.
34. Voedingsraad/Gezondheidsraad (Health Council and Nutrition Council of the Netherlands), Vervolgadvies inzake foliumzuurvoorziening in relatie tot neuraalbuisdefecten. The Hague: Voedingsraad, 1993: 22-24.
35. Of course, in case of consensual sex the other person has his or her own responsibility to act safely. This however does not take away the obligation of non-maleficence of the person who knows to be HIV-positive.
36. The problem seems to be absent in case the professional is convinced that these controversial moral beliefs are true and that clients freely chose to listen to them and adopt these beliefs. After all, some people (professionals as well as laypersons) may have a system of moral beliefs in which the idea is justified that everyone has a duty to guard one's health. However, as prevention is mostly offered (without request) to large groups of people, the health professional cannot assume that clients will have a moral belief system in which such controversial beliefs can be justified.
37. I am grateful to Frans Brom, Robert Heeger and Alex Huibers for their helpful comments and suggestions.