medical legal experts in West Germany, France, and the US39. So, keep in mind that
patient's rights are by no means universal. They reflect the overall values of the society
that generates them.
(3) The right to an interpreter (principle nine). When a radiographer
instructs a patient to take a deep breath and then blow out, he or she had better be sure
that the patient understands because it is crucial to getting an accurate x-ray. If there is
a language barrier, the x-ray technologist must ensure that an interpreter is on hand to
provide necessary translations.
(4) The right not to be experimented upon without prior consent. Consent of
the subject is mandatory for patients participating in experimental research. But the
frequency and manner in which scientific studies, such as randomized controlled trials
(RCTs), are done in different countries reflect to some extent national values.
(a) Randomized controlled trails, in which subjects are divided into two
or more groups, the groups treated differently, and the results compared, provide the
most useful answers. (Randomized control trails apply to nontherapeutic research,
which offers no prospect of benefit to the subject, and to therapeutic research, which
offers some prospect of medical benefit to the patient-subject.) Many doctors question
the use of RCTs in therapeutic research because patients must be treated differently,
with some not treated at all (for the group receiving a placebo).41
(b) For physician-researchers conducting therapeutic research in the
US, the first ethical obligation is to the best interests of the patient. (A rights-based
morality prevails.) Thus, a properly designed, controlled drug trail would be one in
which neither of the proposed therapies could be regarded as definitely better than the
other. In these trails, patient-subjects in the control group would receive the
standardized therapy, rather than a placebo. Thus, there is a benefit to the patient-
subject, regardless of whether he/she receives the standardized or the experimental
therapy.42 (If the physician-researcher should feel that the new treatment is more or
less preferable to standard therapy, then there is a conflict between his or her duty to
the patient, and to the study.) 43
(c) In Great Britain, where RCTs are done more frequently than in any
other country (with Scandinavia and the US closed behind), ethical obligations are seen
in utilitarian rather than rights-based terms. The British are more likely to conduct RCTs
in which one group in definitely not getting beneficial therapy.44 In a country with
socialized medicine, the good of society as a whole is given more importance than the
potential benefit to any individual patient-subject. There is also a general skepticism
about the potential benefit of any new therapy.
(d) In France, on the other hand, where the rights of the individual are
highly valued, and strict privacy laws make data collection virtually impossible, RCTs
are much less common.45
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