Medical Power And Medicalisation

In the sociology of medicine Parson (1951) regarded medicine as functional in social terms. By tackling the person’s problems in medical terms the tendency towards deviance that was represented by ill health could be safely directed, until they could return to their normal self. (Lawrence 1994: p 64-65: BMJ 2004: Parson cited in Gabe, Bury & Elston 2006, p 127).

The American Medical Association (AMA) published a Code of Ethics for Physicians that includes a list of certain principles physicians should follow in order to be good physicians, practicing in an ethical fashion. This list, which was first adopted in June of 1957 and revised as recently as June of 2001, demonstrates some principles that are not universally accepted to be critical to the ethical practice of a physician. In particular, all physicians do not completely believe the claim that “A physician shall support access to medical care for all people” (Principles of Medical Ethics). Theorist, H. Tristam Engelhardt believes that the lack of access to care for some may be unfortunate, but it is not unfair and that this access does not need to be mandated, nor does believing it should be make you an ethical physician. In fact, Engelhardt supremely believes that by providing access of care to all, you will hurt certain patients that already have access to care, negating your function as a physician practicing beneficence. Engelhardt would retract this statement from the Principles of Ethics. However, this belief of and drive to implement access of care to all is critical to one’s job as a physician and it goes against core values of physicians to claim otherwise. Theorists such as Tom Beauchamp and Norman Daniels would agree that the universal access to health care is a critical component of the values physicians hold.

"Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error…" (John Hopkins Medicine). This soaring number has caused medical errors to become the third leading cause of death in the United States. For many people, medicine seems foreign and unknown. People who have lost loved ones due to medical error desperately look for a reason, and many times that blame falls upon doctors. Media has put a negative connotation on doctors as well, causing their reputation to plummet whenever a hospital procedure turns badly. A renown surgeon and author, Atul Gawande, uses his knowledge and experience to give people a new perspective on medicine. In the article "When Doctors Make Mistakes," Gawande uses rhetorical appeals: ethos, pathos, and logos to prove the need for a change in the medical systems and procedures. He analyzes how the public looks at doctors, giving a new perspective to enlighten the reader that even the best doctors can make mistakes.

Unfair competition and socialism amongst physicians and medical students emerged as medicine advanced and health departments were formed. “Nurses in schools were resisted by physicians who would lose some patients if they were cared for at school--city (New York City Health Department) pointed out that they would gain more patients by referral--physicians prevented them from doing any significant medical care.” (Starr.) The demand for care increased as the use of checkups and health exams--insurance, job, school became more commonly used in day-to-day practice. Chapter 5 also introduced a new idea of germ theory, “in the first half of the nineteenth century, some authorities attributed epidemics to cotagonian and recommended quarantines-an ecomonically damaging measure.”

In his essay, The Refutation of Medical Paternalism, Alan Goldman states his argument against a strong doctor-patient role differentiation, in which the doctor may act against a patients’ immediate will in order to carry treatment in the patients’ best interest. Goldman frames his entire argument around the single assumption that a person’s freedom to decide his future is the most important and fundamental right as he claims “the autonomous individual is the source of those other goods he enjoys, and so is not to be sacrificed for the sake of them.”[1] He claims that the majority of people would agree that they are the best judges of their own self-interest

Finally, the third alternative to the paternalistic model is the contractual model. This model is similar to paternalism, in that it questions the assumptions of equality, however it differs in that there is a “contract” between both parties, leaving each with their own dignity and moral authority. What is crucial about this model is that it does not neglect the fact that there is an obvious difference in the degree of knowledge between the patient and the physician. Instead of focusing on that discrepancy, the model concentrates on the agreement between the two parties to exchange goods and services and the enforcement of that by government sanctions. In other words, this model compromises between partnership and the reality of medical care, and according to Veatch, is the only realistic way to share all responsibility, while protecting various parties in health care. For example, both parties are freely entering this contract, and therefore are both given the right to leave it, given proper notice. However, while partaking in the contract, there are duties and obligations of each, which may neglect virtues of benevolence, care and compassion, which we do see stressed in other models.

While most people generally categorize war as a deathly arena consisting of gunfire, the stench of rotten corpses, and the cries of trauma of soldiers; war can be seen as a time for prosperity and growth in the medical profession. The lack of resources in battlefield hospitals, cause people to believe that treatment options are limited. However, history has shown that these limited resources provide an outlet for creativity and exploration, the seeds to advances in the medical profession. During the American Revolution, more casualties were due to illness as opposed to gunshot wounds, opening up the eyes of medical professionals that new ways for disease prevention were needed. Additionally, before World War II biomedical research was limited

In the world that we live in today, many people would find it difficult to imagine living in a world where medicine and treatment are not readily available. The replacement of religious explanations to medical and scientific explanations has become a means of social control. If a person is in pain, they can easily set up an appointment with a doctor and receive some sort of medical diagnosis. However, there are certain instances where a problem has not been medicalized, or recognized as a medical problem, and their issue will be dismissed completely. The movie One Flew Over the Cuckoo’s Nest delves into the idea of medicalization and how it can be used for the good, or for the bad, in terms of the “sick role.” Medicalization in the

The philosophy relayed by the book’s author consistently leads back to the moral question that must be asked in the initial design of the healthcare system. That determination has to do as to whether the government has a duty to act when there are those within their own country do not have equitable access to hospitals and doctors for the treatment of their conditions.14

In this essay, I intend to look into the power of the medical model in relation to people with physical and mental disability. I will look at the impact of medicalization on people with medical impairment as well as some key concepts in medical sociology (Gabe, J. and Elston, M. A.2004). I will then compare the medical model with the social model and consider the effect they have on professionalism and dependency and I will discuss the binaries in the medical and social model plus the political, cultural and economic impact in the society. I will discuss the limitations, policy, guidelines and legislations and how the medical model of disability can contribute to social exclusion, segregation and discrimination, and then look at how this depersonalize and deinstitutionalize people’s individuality and the impact on person-centred care, the infringement of people’s right on issues of confidentiality and autonomy. I explore the challenges of disability and access and the reconceptualising role of the ‘Medical Model’ in issues of disability and rehabilitation. In health sciences, good medical and clinical practices are based on moral and logical thinking. Although the medical model is learned by doctors in their original training and in theory, then brought and adapted to the field of mental health by psychiatrists that inform both mental

ADHD, defiance disorder, pregnancy, these are just few of the things medicalized in the West (Davies 1995). With the rising prestige of Doctors in the 19th century, came a widening of the gap of knowledge between Doctors and the general population (Davies 1995). Doctors have kept a sort of lock on medical knowledge, enabling them to medicalize all sorts of “issues” aided by the idea of the medical mystique. But with the emergence of medicalization and cures that are being searched for by Doctors, a new problem has arisen. This fixation on curing illnesses has led to Doctors viewing patients as experiments and not as human beings, this is seen especially in technologically advanced societies as exemplified in the movie Wit. In addition to this new problem, there are clear establishments of hierarchy between medical professionals such as Doctors and nurses as well as the emotional detachments with the patients which can lead to patients feeling left out and alone.

Illich (1990) even went as to say that themedical proffesion (including pharmaceutical companies and medical equipment suppliers) have a vested interest in illness so they create illnesses which have to be treated by doctors and drugs etc. this means conditions that used to be seen as natural, such as dying or unhappiness have now undergone a social iatrogenesis (doctor caused illness) whereby people cannot handle their own health anymore. postmodernists dislike this use of medical discourse because one theory has more prestige that it should be considered the truth.

The conceptualisation of medicine as an institution of societal control was first theorised by Parsons (1951), and from this stemmed the notion of the deviant termed illness in which the “sick role” was a legitimised condition. The societal reaction and perspective was deemed a pillar of the emerging social construction of disease and conception of the formalised medical model of disease. Concerns surrounding medicalisation fundamentally stem from the fusion of social and medical concerns wherein the lines between the two are gradually blurred and the the social consequences of the proliferation of disease diagnosis that results from such ambiguities of the social medical model.

Imagine you are injured or sick and have sought a doctor’s help. Although you trusted your doctor, something, something seemingly very in control of the doctor, went wrong. You are angry and confused, but also think of the commonality of medical malpractice. So, why do doctors, who are supposed to help, harm? Though many flaws influence it, malpractice can be, and often is unintentional. Most doctors aren’t trained to harm their patients. Inexperience and lack of medical discovery led to unintentional suffering of the patient. Personal flaws, like lack of willingness to abandon previous medical methods and shortcomings in communication also harm patients. Further reasons why doctors harm are socio-medical understandings that breed hate, prejudices stemming from a society’s belief about certain people, such as the medical practice under the Nazi regime. Additionally, displayed in the case of Ignác Semmelweis, judgement of one to oneself can be detrimental to any progress one’s ideas could make. We will examine these concepts through Jerome Groopman’s “Flesh-and-Blood Decision Making”, Sherwin Nuland’s The Doctors’ Plague and Barbara Bachrach’s “In the Name of Public Health”. Those who practice medicine are, unfortunately, unfree from the imperfections that plague all of humanity. Through these intimate and varied faults, doctors do harm.

The treatment of physical and mental problems has undergone a rapid change in the past few decades. An increasing number of bodily and behavioural symptoms now have a recognised medical diagnosis and corresponding treatment. Sociologists have attributed these changes to the process of medicalization, wherein “non-medical problems come to be defined and treated as if they were medical issues” (McLennan, McManus & Spoonley 2009: 271). Medicalization is an ongoing, gradual process which occurs through the social construction of new diseases by groups such as health professionals (Conrad 2007: 4). It can be argued that medicalization is an active and passive process by which diseases are constructed in an attempt to find treatments for patients; and that diseases can be ‘socially’ constructed as well as ‘corporately’ constructed by companies to create a profitable market of consumers. At the micro level of society, medicalization in the Western world has been influenced by liberal notions of individualization which has extended to some parts of the health sector. At the macro level, medicalization has been buoyed by the process of the professionalization, expansion of state monopoly over the health profession and religious and political social movements. Although some academics argue that the medicalization of society is less significant than the process of “de-medicalization”, there is clear evidence that the process of medicalization is intensifying and outstripping the rate