The social institutions of medicine and the state have a complex history of interaction in which doctors have been the originators of political ideals, goals, and social change but equally often have found themselves to be instruments of political authority.
In the iconic painting Broken Column, Kahlo represents her spine as a Greek column that is fractured and disintegrating. In this beautiful and tragic interpretation, the fractured column bespeaks Kahlo’s physical weakness and emotional instability.
In the past, forced sterilizations violated the autonomy of vulnerable women. Today, measures intended to protect such women from the abuses of the past may in fact hamper their autonomy in a different way.
Herman Melville's account of Bartleby the scrivener has something to teach us about the interactive nature of refusal and the empathy necessary for an exchange of values in the setting of conscientious refusal.
Parents want their child with severe disabilities to be accorded the same respect a healthy child gets, including a physical exam in the ER to diagnose and perhaps treat a minor illness unrelated to his or her impairments.
Physicians who have adequately informed a competent patient of his or her diagnosis, its meaning, and medically appropriate options should then accept the patient’s informed consent or refusal of treatment.