A blog from the Centre for Research Ethics & Bioethics (CRB)

Month: October 2011

The economisation of the language of medicine

Two American physicians recently wrote in the New England Journal of Medicine about how they were forced back to school again learning another foreign language. In medical school they learned that measles was called rubeola and itching pruritus. Today they learn that patient is called “customer” (or “consumer”) while doctor and nurse both are called “providers.”

The authors guess that spiralling health care costs drive this “economisation” of their professional language. Economists and politicians believe that the solution to the cost problematic lies in the industrialisation and standardisation of health care. Hospitals are to be run as modern businesses and the traditional language of medicine modified with terms that correspond to the professionals’ new factory functions. Above all, the patient relation is updated as a customer relation.

The two doctors see the economisation of their language as reductionist. It neglects the psychological, spiritual, and humanistic aspects of the relation to the patient. Precisely these aspects made medicine a “calling,” they write. The economisation of medicine concerns not only language, however, but also the organization of work. Doctors are less free to make their own decisions based on their clinical judgment. They are forced to follow manuals written by experts, as if they were on the factory floor following the chief engineer’s scheme.

When I read the article I thought that an alternative way of formulating the problem is in terms of means and ends. The authors’ note that clinical care always had a financial aspect, but the treatment of the patient still was in focus as the doctor’s primary goal. When profit took overhand as the goal, it was seen as a betrayal of the doctor’s calling and worth ridiculing, as in Moliere’s plays. The economisation of medicine turns the relation of means and ends inside out. The end of treating the patient is snatched out of the doctor’s hands and become a means towards other, economic ends. The analysis of the alienation this means is old and it is tempting to hear echoes from another century in the article’s finish, which I cannot avoid paraphrasing: “Doctors and nurses of the world, unite! Through off the language that demeans both patient and professional and that threatens the heart of medicine!”

Simultaneously, one must admit that new generations grow up that do not seem alienated in this new world, but act as self-evident consumers of health care.

Pär Segerdahl

We have a clinical perspective : www.ethicsblog.crb.uu.se

Does my blood sample make me a research subject?

When my blood sample is reused in biobank research, perhaps 5-10 years after I gave it, do I then become a research subject who must be informed about the new research project and give my assent before the sample is used?

The question arises when I read Joanna Forsberg’s article in BMJ on biobank research and the comments it received. She questions assent for each new biobank project in an interview on Nature News Blog. She thinks it is sufficient that the project has taken precautions that guarantee anonymity and is reviewed by an ethical review board.

Contacting people in thousands long after they gave their samples is not only costly, it also means drop out of samples threatening the validity of the results. Joanna thinks we all have an interest in the existence of biobank research even if we do not gain from research on precisely the samples we gave. Today vaccination against cervical cancer can be offered because in a biobank with patient samples from 1969 a connection was found between HPV virus infection and subsequent falling ill. As a reasonable solution Joanna therefore suggests broad consent to the use our samples in future biobank research.

I don’t know if research on my ten-year-old blood sample makes me a research subject today. One thing is obvious: biobank research does not resemble the standard image of medical research where research subjects after consent undergo treatments and regularly are tested.

Pär Segerdahl

We like ethics : www.ethicsblog.crb.uu.se