Subramani Supriya
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
Asian Bioeth Rev. 2019 Dec 4;11(4):349-366. doi: 10.1007/s41649-019-00106-1. eCollection 2019 Dec.
In this paper, I examine the rhetoric employed by court judgements, with a particular emphasis on the narrative construct of the 'passive patient'. This construction advances and reinforces paternalistic values, which have scant regard for the patients' preferences, values, or choices within the legal context. Further, I critique the rhetoric employed and argue that the use of this rhetoric is the basis for a precedent that limits the understanding and respect of patients. Through this paper, I present the contemporary use of the 'passive patient' construct in the context of the Indian legal system and describe how such constructions have become a source of normative justification for legal reasoning that jeopardizes the patient's agency. I argue for the primacy of 'respect for persons' within Indian law and the need to treat each patient as a who has agency, preferences, and values during clinical interactions. I conclude by suggesting that laws that adopt narratives that acknowledging the significance of patient engagement and the relevance of effective communication during clinical encounters would help cultivate a culture of patient-centred care, by moving beyond the rhetoric of 'passive patient' and the 'health/choice' dichotomy.
在本文中，我审视了法院判决所采用的修辞手法，尤其着重于“被动患者”的叙事结构。这种结构推进并强化了家长式价值观，而这些价值观在法律背景下对患者的偏好、价值观或选择几乎不予考虑。此外，我对所采用的修辞手法进行了批判，并认为这种修辞手法的使用是一个先例的基础，该先例限制了对患者的理解和尊重。通过本文，我呈现了“被动患者”结构在印度法律体系背景下的当代应用，并描述了这种结构如何成为危害患者自主性的法律推理的规范性正当理由来源。我主张在印度法律中“尊重人”的首要地位，以及在临床互动中将每位患者视为具有自主性、偏好和价值观的个体的必要性。我在结论中提出，那些采用承认患者参与的重要性以及临床诊疗过程中有效沟通的相关性的叙事的法律，将有助于超越“被动患者”的修辞手法以及“健康/选择”二分法，从而培育一种以患者为中心的医疗文化。
