Autonomy and care in the logic of competing and solidarity relations in medicine

Abstract

The interactions of the subjects of medicine are considered in the projection of two logics: solidary and competing relations. This approach develops the critique of the dominance of the concept of patient autonomy that comes with the bioethics represented in the ethics of care by K. Dörner, A. Moll and others. The conceptual forms of competition and solidarity are identified as oppositions to power and equality, autonomy and care, individualism and interdependence of subjects of medicine, anti-paternalism and paternalism, neglect and attentiveness, the legal and ethical meaning of informed consent, control and compliance, medical services and medical care. In medicine, from point of view of bioethics, the solidary relations could be expressed in a paternalistic model. It is based on ethi-cal connotations such as doctor's responsibility and mutual trust. Autonomy has a legal and economic predication. The ethics of care, traditional for the Russian cultural model, implies not so much the doctor's authorities over the patient, recognizing him as unequal in medical decisions, but in modern healthcare it can be combined with a voluntary expression of consent to medical interventions with the properly provided information.