Beggining in the mid-1960s, the practice of medicine in the United states underwent a most remarkable - and thoroughly contorversial - transformation. Although the changes have altered almost every aspect of the relationship between doctor and patient - indeed, between medicine and society - the essence can be succinctly summarized: the discretion that the profession once enjoyed has been increasingly circumscribed, with an almost bewildering number of parties and procedures participating in medical decision making. As late as 1969, the philosopher Hans Jonas could assert that “the physician is obligated to the patient and to no one else… We may speak of a sacred trust; strictly by its terms, the doctor is, as it were, alone with his patient and God.” But even as he wrote, the image of a physician alone with a patient was being supplanted by one of an examining room so crowded that the phyysician had difficult squeezing in and of a patient surronded by strangers. (p. 1)
Começa assim…
E se esta Introdução («Making the Invisible Visible») coloca o enquadramento, da transição e da mudança da imagem (que não é apenas do médico e do doente mas da medicina e da sociedade), acompanha-se uma certa visão do desenvolvimento das tecnologias e da ciência, nas décadas de 60 a 90, com muitas raízes na II Guerra Mundial - sobretudo as da investigação e da decisão clínica.
Aborda alguns dos casos mais famosos da bioética e da ética médica, como de Karen Ann Quinlan, bem como o percurso para a criação da National Comission for the Protection of Human Subjects (alguns anos depois de Walter Mondale ter proposto que fosse criada uma comissão que desse conta, ao público, das implicações éticas, legais, sociais, políticas dos avanços biométicos) sob o tema «Comissioning Ethics» (cap. 9) e as análises em torno dos transplantes, da decisão no final de vida.
Além de recomendar a leitura crítica, deixo um pouco do capítulo 10 «No One to trust»:
“The movement to bring new rules to medecine did not stop at the biomedical frontiers. Beginning in the early 1970s, the most elemental aspects of medicine - decision on birth and death, on what lives were or were not worth living - became the center of public debate and controversy. Traditionally, those questions had been at the essence of bedside ethics, the exclusive presence of doctors: (…) Athrough the progression from issue to issue seemed logical, even inevitable, the reality was more complex, and each shift was bitterly contested at every point.” (p. 190)
E, capítulo final, há «New rules for the Bedside», claramente. Embora David Rothman não pareça satisfeito, admite que:
“Reviewing these events, and speculating about the future, suggests that the transformation in medical decision making, as vital as they are, have come with a price. To alter the balances between doctors and patient and medicine and society encouraged, unavoidably, the intervention of a greater number of thrid parties.” (p.260)
“In the end, patients may well continue to experience medicine as modern: powerful and impersonal, a more or less efficient interaction between strangers“. (p.262)
É uma visão das coisas… e vale a pena conhecer mesmo as que são diferentes da que julgamos ter.
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