Social Construction and Bioethics

Two key points of contention distinguish Parsons's theory of the sick role from labeling theory. The first is whether physicians have patients' interests reliably at heart. Parsons, in claiming that physicians have a "collectivity orientation," signals his confidence that they do. For labeling theorists, however, claims of altruism are utilized to cloak self-interest. This difference in attitude is very apparent in the writing from each orientation on the role uncertainty plays in medicine. From a Parsonsian orientation, uncertainty is a problem to be overcome and a psychological burden to physicians (Fox, 1959). From a labeling orientation, uncertainty is a ploy that physicians magnify in order to control patients (Davis).

The second key difference between Parsons and the labeling theorists concerns patient autonomy. For Parsons, the only autonomous decision made by the patient is the one to seek care. After that, patients simply, and appropriately, follow the doctor's orders. Since the physician has the patient's best interest in mind, there is no reason for the patient to balk or to question. For labeling theorists, there is no reason for the patient to follow medical regimes without question, since there is no guarantee that the physician has the patient's best interest in mind.

Informed consent is based on the principles of autonomy and self-determination. Sociological description of the doctor-patient relationship, whether from Parsons or from the labeling theorists, illuminates the absence of autonomy and self-determination. Sociologists differ on the necessity and value of such principles.

The earliest sociological studies of death and dying (those of Barney Glaser and Anselm Strauss, published in 1965) described the extent to which autonomy and self-determination were missing in the doctor-patient relationship. Physicians operated in what Glaser and Strauss called a

"closed awareness context." Physicians knew of fatal conditions but routinely did not pass this information on to patients, and they often colluded with family members to keep this information from patients. These practices were rationalized as kinder than being candid.

Because of informed consent, a veritable revolution occurred in the doctor-patient relationship. Candor replaced evasion. With informed consent, patients are more than ever the masters of their own treatment. The paternalism that marked Parsons's description of the doctor-patient relationship has given way to a more egalitarian, more formally contractual, relationship. While there is much to celebrate in these changes, something may have been lost. There are costs involved with a fuller patient autonomy. Under the banner of autonomy, physicians may hide behind their role as technical experts and leave weighty matters to patients. There are also new possibilities for the psychological abandonment of patients.

CHARLES L. BOSK (1 995) REVISED BY CHARLES L. BOSK JACQUELINE HART

SEE ALSO: Alternative Therapies; Anthropology andBioethics; Bioethics, African-American Perspectives; Body; Eugenics: Historical Aspects; Feminism; Insanity and the Insanity Defense; Lifestyles and Public Health; Medicine, Sociology of; Mental Illness; Race and Racism; Sexual Identity; Women, Historical and Cross-Cultural Perspectives; and other Health and Disease subentries

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