A television may seem at first sight an object in a medical journal, but this is, after all, a magazine whose theme is "softer" side of medical science. Addition The doctor Humanities authors use the site and the popularity of "House MD" to ask important questions about medical ethics, and to meet the expectations of our society.

Officially agreed, all over the world, that patients have almost absolute right to decide their own destiny medical. In particular, if the patient is incompetent, the physician is (after all you need to inform patients about all available options and potential risks and benefits of each) to postpone a final decision on the patient - even if the doctor is in strong disagreement with this decision. Thus, a behavior that is in practice, Dr. House is generally difficult.

So the question is: Since the House extravagant violates the autonomy of his patients when he finds an opportunity to do so, joyfully proclaiming his great contempt for individual rights, so why is his story so popular? And what does the popularity say about us?

The idea that patient autonomy is and should be the dominant principle of medical ethics, of course, is fully compatible with the Enlightenment ideal of individual rights. This ideal first developed in Europe, nearly 500 years ago, but had trouble taking root there, and really only flowered when Europeans first came to America and had the opportunity to get to work in a isolated area, where rigid social structures are not already in place. The development of this ideal culminated with the declaration of American independence, which our founders declared individual autonomy (life, liberty and the pursuit of happiness) to be an "inalienable right" granted by the Creator, and thus before and during outweigh any government created by man. And since that time takes precedence over the individual in American culture have more or less, remained our general principle of operation.

Individual autonomy - or to put it in more familiar terms, individual freedom - is a fundamental principle of our culture, and is one that is always worth fighting and dying to defend.

So the idea that the autonomy of the individual should be very clearly the most when it comes to making medical decisions is simply a natural extension of the ideal first American. Of course, most believe that this should be the fundamental principles of medical ethics.

Unfortunately, it is not so easy. There is another principle of medical ethics that has a history even longer than that of autonomy - the principle of beneficence. Charity demands that the physician must always act to maximize profits - and minimize the damage - to the patient. Charity recognizes that the physician has special knowledge and large, it is not easy to duplicate, and therefore has a special obligation to use this knowledge - always and without exception - to do what the patient knows best. Dr. House is a great defender of the principle of beneficence (if caustic and abrasive about expressing it). DrRich believes that House is less popular, partly because of the benefits to be derived from a patient through the principle of beneficence - that is, medical paternalism - are plain for all.

Apparently, the principles of individual autonomy and good times in conflict. When two ethical principles are valid and legitimate to be inconsistent, which is called an ethical dilemma. Ethical issues are often resolved or consent or by force. In our case, this problem has been solved (for now) by consensus. The international community has deemed individual autonomy to predominate over good medical decisions.

DrRich point here is that Dr. House (the champion of charity) is absolutely false. In fact, she married a dedicated precept of medical ethics, which until recently was the precept of medical ethics. There is much to say about the charity. Make the "right" medical decision often requires a deep and sophisticated options, the knowledge that is often beyond the reach of many patients. And even sophisticated patients who are truly medically literate often lost when they are sick, helpless and afraid, and his ability to make difficult decisions is diminished. Perhaps, some (like House) argue that autonomy should not be your main concern right now. In fact, one could say that in a perfect world, where the doctor, in fact, almost perfect knowledge and appreciation of almost perfect what is best for the patient, beneficence should take precedence over autonomy.

It is instructive to examine how and why autonomy came to be declared, by universal consensus, the dominant principle of medical ethics. It happened after World War II as a direct result of the Nuremberg Tribunal. During that Tribunal the trials against Nazi doctors revealed heinous behavior - generally involving medical "research" on Jewish prisoners - that exceeded all bounds of civilized activity. It was clear that in certain circumstances (circumstances which under the Nazis were extreme but which were far from unique in human history) individual patients could not rely on charity in the community or charity or government the charity of their own doctors to protect them from harm at the hands of authority. Thusly, the ethical commandments, which asks patients ultimately to rely on the kindness of other net proved totally inadequate. The command of individual autonomy, and therefore won by default.

After Nuremberg Code formally declared individual autonomy to the rule that prevails in medical ethics, and beneficence, it is important to be a secondary concern. If a conflict arises, the patient's autonomy is to win. It is important to note that this statement was not a positive statement about how to honor individual autonomy is the top of human ethical behavior, but it was a negative opinion. Under duress, admitted the Nuremberg Code, communities (and their agents) often behave very badly, and ultimately the individual himself can be relied upon to at least try to protect its own interests.

DrRich will take the next step. When our founders made individual autonomy the organizing principle of a new nation, they also made a negative statement. Their observation of human history (and anyone who doubts that our founders were familiar with the width of human history should re-read the Federalist Papers), they found that subjects could not rely on any earthly authority to protect their life and physical integrity, or their individual rights. Mankind has tried all the different authorities - kings, priests, heroes and philosophers - and individuals were then trampled by them all. For this reason our founders declared individual liberty to be the cornerstone of our new culture - because everything else had been tried and failed. In the spirit of the Enlightenment, they agreed to try something new.

There is a problem inherent to individual autonomy based on the ethical principle of medicine in chief, ie, patients not infrequently self to make very bad decisions for themselves, then have to pay the consequences. The same happens when we rely on individual autonomy as a guiding principle in the operation of our civic life. The ability of individuals to themselves - to succeed in a culture of competition - not the same, and if the results are decidedly mixed. Autonomous individuals often fail - either by personal limitations, bad decisions or bad luck.

So if we talk about medicine or society as a whole, in defiance of our fundamental principles, we will always have a tendency to return to a state of dependence - of relying beneficence of some authority in the hope of more overall security or fairness - the sacrifice of our individual autonomy. In estimating DrRich the popularity of "House MD" is fully compatible with this trend. (In fact, the authors almost make Dr. House as attractive a person as he is, just to dampen our enthusiasm for an authority figure who always knows what is best for us and act on this knowledge, come hell or high water.)

Those of us who defend the principle of individual autonomy - and the economic system of capitalism that the flow of it - all too often forget where it came from, and DrRich believes, therefore, can be so difficult to defend. We - and our founders - did not accept the peak of all human thinking, but a very practical reason that gives ultimate authority to another entity, sooner or later, guarantees tyranny. This was true in 1776, and found many experiments in socialism we have seen throughout the world in the last century, is even more true today.

Individual self-determination principle always very imperfect organization, as well as health care, and society as a whole. Acceptable in principle do you continue to work hard to find a way to overcome the inequalities net, without giving too much power to corrupt some central authority. This is the great American experiment.

Those of us who have the privilege of being Americans today of all days, we find much discussed. But earlier generations of Americans faced challenges that were equally difficult. If we continue to remind us of what is at stake, and that while our system is not perfect nor perfectible, much better than any other system that has never been tested, and we can continue to improve without ceding our destiny - medical or civil - to corruptible central authority, then perhaps we can keep this great American experiment is going on, and finally delivered intact to another generation to face challenges yet another generation.