Research

Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?

Jacquineau Azétsop¹ and Stuart Rennie^2,3

¹  Faculté de Médécine Teilhard de Chardin, Complexe Médical le Bon Samaritain, N'djaména, BP 456, Chad

²  Department of Philosophy, University of Cape Town, Cape Town, Private Bag X3 Rondebosch7701, South Africa

³  Department of Social Medicine, University of North Carolina School of Medicine Chapel Hill, 333 S Columbia Street MacNider Hall, Room 348, CB 7240, Chapel Hill, NC 27599-7240, USA

author email corresponding author email

Philosophy, Ethics, and Humanities in Medicine 2010, 5:1doi:10.1186/1747-5341-5-1

Published:	18 January 2010

Abstract

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy.