Patient Autonomy and Spain's Economic Policy: Crisis and Employment History

4. The Patient's Evolving Role in the Health System

The patient is the ultimate goal of health care and has acquired a prominence it never had before. Health care no longer focuses solely on healing the sick but has incorporated other crucial aspects of the doctor-patient relationship, including:

• Humanization of care
• Adequate information
• Handling claims
• Hospital and medical choice
• Privacy
• Informed consent
• Palliative care

The patient's role is continually modified, granting them greater access to information (about the disease and its symptoms), a greater ability to pursue claims, and increased decision-making power regarding their illness. Regulation has formalized this relationship, notably through the Patient Autonomy Act (Law 41/2002), which governs patient autonomy and the rights and obligations regarding information and clinical documentation.

This shift is also driven by cultural changes in developed societies where basic welfare levels are covered, leading to an increase in demand for medical services (a change welcomed by the private sector). There is a growing tendency to seek a medical or pharmaceutical solution for human suffering, whether real or induced by the society in which we live. This includes aspects of life that are not diseases but changes associated with age or life situations.

Induced Diseases and Medicalization of Suffering

There are also induced diseases, where drug companies, doctors, and the media play an important role, often indirectly touting supposedly new drugs for diseases.

To avoid the medicalization of human suffering (the name given to these situations), several actions are necessary:

1. Education regarding the demand for health services.
2. Limiting certain professional attitudes.
3. Recognizing that medicine has no solutions for a wide range of problems.

Many conflicts and concerns cannot be classified as diseases and must be resolved by individuals without resorting to medication or medical treatment, thereby avoiding potentially irreparable errors. The attitude of the physician is crucial in these situations, which occur with increasing frequency due to the rapid changes in our societies.

The patient's attitude must also be more critical, recognizing that the doctor does not hold the solution to every conflict, and that occasional discomfort is a necessary part of life, not always a disease requiring intervention.

Social and Employment Policy in Spain

Introduction: Unemployment and Economic Cycles

At present, one of the situations of most concern to the Spanish population is unemployment. Between 2000 and 2005, there was talk of full employment, and indeed, Spain approached this goal. However, economies are cyclical, experiencing moments of crisis and calm.

Currently, we face a financial and mortgage crisis that affects the production of goods and services, and consequently, employment. This situation has prompted public authorities and international agencies to take necessary measures to address economic recovery. This chapter aims to describe the measures taken so far and, though difficult, predict their potential impact on employment.

Economy and Employment in Spain

We distinguish two major stages:

1. The 1970s, marked by the historical moment of the transition and the adoption of the Constitution in 1978.
2. The present crisis, characterized by profound changes.

1. Economy and Employment in Spain in the 1970s

This stage was defined by an energy crisis that primarily affected Western countries. In Spain, a series of internal events complicated the national response to this crisis. These factors included:

• The change of political regime and the transition process.
• A protectionist economy.
• Pressure from trade unions after a long period of imposed silence.
• The Spanish industry's failure to adjust to new market conditions.

These factors led to a significant increase in the deficit, increased aid to companies to offset losses, currency devaluation, and a sharp reduction in foreign investment.

The first adjustment measures were adopted in 1977, known as the Moncloa Pacts. These included the devaluation of the peseta, a moderately restrictive monetary policy, and an incomes policy, coupled with a commitment to structural reform.

Since Spain's integration into the European Union, the country has generally maintained strong growth. However, the energy crisis of the 1970s and the subsequent necessary process of re-industrialization caused intense job losses in different parts of the country—a problem that has persisted even during stages of higher economic growth.