Tıbbi Müdahalelerde Onam Hakkının Sınırı Olarak Üstün Yarar
Özge YücelTıbbi müdahaleler niteliği bakımından kişilik hakkına müdahale oluşturmaktadır ve bu nedenle kişilik hakkını ihlal etmemesi için öncelikle ve kural olarak ilgilinin onamının alınmış olması gereklidir. Tıbbi müdahalede biyoloji ve tıbbın elde ettiği nitelikli bilginin kullanımı sebebiyle onamın hukuka uygunluğu belirli özel koşulları gerekli kılmaktadır, bu koşullardan biri de onamın meşru bir amaca yönelik olarak verilmiş olmasıdır. Öte yandan biyoloji ve tıbba ilişkin özel, nitelikli bilgi toplumsal düzen açısından iktidar sahiplerine tehlikeli bir araç sunmaktadır. Onam yerine geçen hukuka uygunluk sebepleri anayasal ilkeler doğrultusunda yasallık, ölçülülük gibi kriterlere uygun olarak somutlaştırılarak kişilerin bedenleri üzerinde onam alınmaksızın müdahalede bulunulabilmektedir. Söz konusu hukuka uygunluk sebepleri, tıbbi müdahaleler söz konusu olduğunda üstün yarar kavramı altında özelleştirilebilmektedir. Onam alınmadan gerçekleştirilecek müdahale ilgilinin kendi yararına veya üçüncü bir kişi yararına olabildiği gibi genel olarak kamunun yararına da olabilir. Ne var ki gerçekte neyin hastalık olduğu veya hangi müdahalenin kime göre nasıl bir yarar sağlayacağı salt bilimsel değil, aynı zamanda politik bir meseledir. İlgilinin kendisiyle veya yasal temsilcisiyle çatışma içine düşülerek girişilen tıbbi müdahalelerin meşruluğunun sınırları eleştirel bir yaklaşımla değerlendirilmiştir.
Superior Interests as a Limitation on the Right to Refuse a Medical Treatment
Özge YücelMedical interventions constitute an intervention in personal rights in terms of the nature of medical interventions. Therefore, consent of the concerned person should be obtained as a rule to refrain from violating the right to personality. However, the lawfulness of consent requires specific conditions owing to the use of qualified information obtained by biology and medicine in medical intervention. One of such conditions is that consent should be given for a legitimate purpose. Conversely, qualified information obtained by biology and medicine offers decision-makers with a dangerous tool for structuring social order. The reasons for lawfulness replacing consent are embodied in accordance with certain criteria, such as legality and proportionality, in line with constitutional principles. However, in terms of medical interventions, the concept of superior interests may supersede the reasons for compliance with the law. The intervention to be carried out without consent can be either in the interest of a concerned person, a third person, or the public in general. However, which disease or form of intervention will benefit from whom is not only a scientific but also a political issue. Thus, the study critically evaluates the limitations of the legitimacy of medical interventions attempted by engaging in conflict with the person concerned or with a legal representative.
The values of personality are interrelated, a person’s body, mental existence, and social integrity are in constant interaction with one another; consequently, an intervention directed toward one affects the others. Similarly, medical intervention for physiological integrity exerts important effects on the psychosocial existence and integrity of a person. The nature of the method and information used are aspects that characterize intervention to personality values as medical intervention rather than the objective of the intervention or who conducts the intervention.
In general, a person exposed to an intervention using medical information is situated in a weak position owing to the lack of this information. Moreover, the fact that the relationship established with a patient or a counselee is at risk of exploitation is also based on this asymmetry. Such qualified information not only leads to the establishment of a hierarchical relationship but also is instrumentalized by the ruling owner for the continuity of order. Furthermore, obedience from individuals is transformed into a tool of social control over bodies through various arguments and medicine. Thus, the present study highlights the effects of social control motivation on the condition of usefulness in medical interventions from the viewpoint of biopolitics. When the conditions of the lawfulness of consent are reviewed using the aforementioned approach, interventions should not be considered necessary for health or beneficial in terms of health welfare. However, they should be oriented toward a legitimate purpose. When such interventions are declared necessary or beneficial for health in line with subjective evaluations, an unjustified restriction can be imposed on the right of individuals to determine their relations, body, and future. In other words, a certain lifestyle can be imposed on individuals. Moreover, it recommendations within interventions may change over time in terms of the nature of the disease and, therefore, cases that require medical intervention. Notably, medicine is extremely political, especially in terms of mental illnesses.
Although the concept of superior interests is arguably the mainstay of all medical interventions without consent, no real conflict exists in terms of the will of the person in terms of medical interventions for personal interests based on the assumed consent. This study discusses the legitimacy of medical interventions conducted without consent of the person or their legal representative. Moreover, distinguishing the criteria regarding conflict with legal representatives as discussed herein is necessary. However, legal representatives are not entitled to evaluate and make decisions arbitrarily because they make decisions for another person’s body and not theirs. The sole purpose of the powers granted to legal representatives is to protect the interests of mentally incapable persons, to allow the necessary interventions, and to prevent unnecessary interventions. At this point, if the mentally incapable person that requires intervention does not resist, refuse, and, therefore, does not engage in conflict, then the interests of the said person have decisive importance instead of the opinion of the legal representative. In this respect, the study discusses vaccines for infants and differentiates them from mandatory vaccines intended for adults. By contrast, in a situation where a competent person who is undergoing medical intervention is engaged in a conflict with him the legal representative, whether the consequences that may occur owing to the lack of intervention will damage the state power or the fundamental rights and freedoms of others should be examined. The rationale for preserving an abstract state power frequently does not serve other interests apart from disciplining people and obtaining their obedience.
If the benefits provided by an intervention are considerably nonsignificant in the face of the burdens that the intervention creates for the individual in the case of violation of autonomy, intervention should be avoided because it cannot be regarded with proportionality as per the Constitution. One of the aspects that must change is the regulation that envisages forced examination for victims of sexual violence because the compulsion of the victims will create secondary trauma and will lead to continued violence. Alternatively, the present study emphasizes that exceptions should not be made for the avoidance of intervention without consent. This condition applies to biological substance donation and experiments for scientific purposes only owing to the lack of moral justification for expecting an individual to make sacrifices despite the fact that the conditions of the person do not create a burden for society.
