Challenges to Medical Autonomy

Along the line of decision making doctors have always argued that the only person who can evaluate the work of a doctor is a fellow doctor. However, medical autonomy has been increasingly challenged in recent years. The effectiveness of medical treatments has been challenged as the number of court cases increase and when the cost of imdemnity insurance becomes almost unaffordable the societal consequences are far reaching.
We are at the point now when the determination of terminal illness is not soley a medical decision, but rather a hybrid medical, ethical, social, political and legal determination. It is clear that hospital admistrators/managers and health insurance companies have exerted a certain amount of control over doctors. Managers can direct funding from one medical specialty to another; or from hospitals to community-based practitioners. Challenges have also come from the professionalization of other 'paramedical' occupations, especially nursing, which has developed into a more autonomous profession with its own professors of nursing in many universities.

The medical profession is also acutely aware of how the profession as a whole is represented in factual and fictional media. Doctors may still be heroes in fiction, but intense public attention has been given to the villains. Their power to promote stereotypes,as protraying people with mental illness as violent, helps us understand how the media sometimes represent health and illness. The media has breeched taboos to put important and vital issues on the public agenda,in the case of aids, bowel and testicular cancer. It has to be credited with provoking debate on the ethics of scientific and medical developlents and keeping a focus on stem cell research. Medical practioners can with ease suggest behavioural changes to their patients based on what is 'on the news'.

Within medicine, there have been attempts to change the heirarchical structure of the profession and to embrace complimentary therapies such as homepathy and accupunture. The new strides in transgenics, gene therapy and the gamot of genetic engineering will provide many opportunities for collaborative efforts.