Who Owns Your Health? - Medical Professionalism and the Market State

Preface vii Abbreviations x Declaration of Geneva xiii 1 The corporate challenge to medical professionalism 1 I. Leadership in an increasingly privatised global health care system 2 II. Historical tensions in medical professionalism and health policy 6 III. The medical profession and consolidation of the market state 23 2 Medical professionalism and 'integrated' regulation 40 I. Regulating medical professionalism in a new global social contract 41 II. Practical issues for 'integrated' regulation of medical professionalism 73 3 Corporate influence on professional education 83 I. How to cultivate a knowledge elite 84 II. Educating medical professionals for life in a market state 90 4 Corporate influence on institutional medical ethics 101 I. The problems of centralisation and self-regulation 102 II. Guidelines and clinical pathways as corporate directives 112 5 Health law as a corporate marketing strategy 119 I. Medical malpractice and system error 120 II. Consent: Trust and the human right to inviolability 130 III. Informed consent: The fictions of democratic legitimacy and patient autonomy 134 IV. The medical fiduciary: Can virtue be coerced? 145 V. Contract: Should vulnerable patients contractually bargain? 149 VI. Confidentiality and privilege: Protecting trust and loyalty 154 VII. Criminal law: Abortion and euthanasia 159 VIII. Public health legislation 169 IX. Constitutional law: The right to health 173 6 Medical professionalism in the modern armed conflict zone 181 I. Medical professionalism, torture and corporate-controlled wars 182 II. Biosecurity and militarisation of the market state 187 III. Medical leadership and violations of patient human rights 191 7 Managed care and the global public private debate 199 I. Liberalising global health care 200 II. The role of the pharmaceutical and medical device industries 207 III. Promoting global public goods in health care 228 8 Medical professionalism in an ideal global society 235 I. Reconceptualising medicine's social contract in the age of corporate globalisation 236 II. Critical reflections on the ideal approach 249 III. Final reflections 260 Notes 267 Further reading 283 Index 286