contract and to junior doctors’ working hours. In medical practice this intrinsic
conservatism leads in some cases to the continuance of discredited practices in the face
of both evidence of the need for reform and demand for change. In assumptions about
what it means to be entrusted with the health of patients doctors (and other health care
professionals) have often taken it upon themselves to make decisions affecting
individuals without reference to individual patients’ own perspectives of the limits of
discretion involved in allowing such trust. Thus, for example, generalised practices such
as withholding information from dying patients about the fact of their dying may have
been justifiable when medicine had little to offer beyond indentifying the terminal stage
of a life. But medicine’s inherent conservatism has allowed this practice of ‘benevolent
paternalism’ to continue in the form of therapeutic privilege (by which a doctor can use
discretion to withhold information she or he considers to be harmful to the health of the
patient) and in the concession given to doctors in the Data Protection Act whereby the
right of access to medical information is only partial in so far as a medical practitioner
retains the right, when a patient requests to see her or his medical records, to remove
information that the doctor believes not in the patient’s best interest to read. While such
clauses may well emerge from good intentions, it is clear that restrictions of this type
offer those with a tendency not to trust the medical establishment further reason to be
suspicious ofhealth care practitioners. This can, therefore, contribute to a climate of
distrust from the patients ’perspective. Indeed, the cynic would have some justification
in noting that leaving this gate-keeping function in the hands of the same professionals
who stand to be criticised provides the very conditions in which corruption and
untrustworthiness can thrive. All this serves to reinforce the dispositions of those who
are disinclined to trust health care professionals.
Until the breakaway from the direct and overt domination of medicine (a process that
began in the UK during the 1960s and culminated with the publication of the first UK
code of professional conduct for nurses in 1983), nurses are known to have colluded in
perpetrating what we would now consider to be betrayals of trust by health care
professionals. Examples of such betrayals fill the pages of three particularly poignant
and influential critiques of professional activity published between 1964 and 19843.
These texts detail example after example of institutionalised abuses of trust by health
care professionals in the name of treatment and care of patients of all ages and
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