Analysis Of The Physician-Patient Relationship

In his article “Whose Body Is It, Anyway?”—appearing in the New Yorker in October 1994—Dr. Atul Gawande highlights the complexities of the doctor-patient relationship vis-à-vis patient autonomy and decision-making. Dr. Gawande explains that a respect for patient autonomy (i.e., allowing patients to choose between courses of treatment, therefore directly influencing their health outcome) is the “new normal” for medical practitioners. However, Gawande also contends that there are times when patients are better served by a voluntary relinquishment of that autonomy.

There are many social factors that can impact on the Doctor Patient relationships everything from race to gender. To break it down and find five, I started with Doctors personal views he is under pressure to be ethical when he may not entirely be accepting of a person’s beliefs or sexuality. For instance a doctor may be homophobic and have a patient attend surgery asking for advice on practicing safe sex and being HIV aware. Following on from this may be a patients confidence in doctors due to race for example a person who has racist issues would not feel comfortable attending a foreign doctors surgery. To find a third I would have to say gender being a female I tend to talk easier to a female doctor, which persists problems as my female doctor only works three days a week so I put off going to see the male doctor so therefore remain ill longer. My fourth factor is age, as the doctor could be old and the patient adolescent. This would impact on different generations living different lifestyles and changing societies. “Adolescence is indeed a tempestuous period”, (Thorne, B & Lambers.1998). Finally I find language barriers a major social factor as if you can’t understand what your doctor is saying to you it has complications in treatment and there is not always a translator available.

The concept of paternalism involves the notion that one person, generally a person in a position of authority, has the right to intervene and override the autonomy of another person. In terms of historical context, medicine is one area in which paternalism has occurred frequently. Throughout the ages, physicians and doctors have been placed in a position of authority in which they acted upon the bodies of their patients without those patients’ full knowledge or understanding. However, there has been a distinct shift in modern times regarding paternalism. With the publication of The Silent World of Doctor and Patient, Jay Katz advocated for a new attention to be given to the autonomous control of the patient. Katz noted that historically speaking,

Another issue with the implementation of Informed consent arises when the patient waives the right to Informed consent and leaves the right to make the decision on the physician. Though legally correct, this can cause psychological stress for the physician especially when the decision is about a life threatening medical condition. Moreover, this also makes the patient vulnerable to abuse. (Manthous, DeGirolamo, 2003)

Goldman’s critique of medical paternalism demonstrates the right for patient autonomy and decision to choose a treatment best suited to their needs and interests. Initially, physicians would not announce any form of cancer to their patients, as it was believed to result in physiological distress. Luckily, medical paternalism continues to be rejected in medical situations; the topics of outcomes research, scientific evidence, and court decisions help correct patient decisions on the best treatment.

Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed

To argue the first premise, he appeals to common knowledge that doctors hold their occupations because they are more knowledgeable in a medical context on the options for improving health and longevity. With this in mind, he then establishes that individuals who consult physicians do so in order to prolong their life and improve their well-being. By establishing these foundational premises for paternalism in a medical context, Goldman can now argue that given a patient that is determined to be acting out of line with his true values and his actions might result in harm that is severe, certain, and irreversible, it is the physician’s professional to override the patients’ immediate rights in order to preserve that patients’ more long-term desires. But how can the physician determine whether the patient is acting in line with his true values in the case of withholding medical information from the patient?

De Bord, J. (2014). ETHICS IN MEDICINE University of Washington School of Medicine. Retrieved from https://depts.washington.edu/bioethx/topics/consent.html

Over the span of half a century, the medical profession has witnessed a catastrophic shift in the patient-physician relationship. As the manufacturing of new pharmaceuticals and the number of patients under a physician’s care continue to rise, doctor’s are finding it difficult to employ the time-honored principles listed within the Hippocratic Oath. This oath, written in 430 BC by the Greek Physician, Hippocrates, was the first document to state the responsibilities of a physician to his patient (vadscorner, pg 2). Hippocrates believed that it was the physician’s duty, as a healer, to treat the patient infected with the disease to the best of his ability, and not to treat the disease

Finally, the third alternative to the paternalistic model is the contractual model. This model is similar to paternalism, in that it questions the assumptions of equality, however it differs in that there is a “contract” between both parties, leaving each with their own dignity and moral authority. What is crucial about this model is that it does not neglect the fact that there is an obvious difference in the degree of knowledge between the patient and the physician. Instead of focusing on that discrepancy, the model concentrates on the agreement between the two parties to exchange goods and services and the enforcement of that by government sanctions. In other words, this model compromises between partnership and the reality of medical care, and according to Veatch, is the only realistic way to share all responsibility, while protecting various parties in health care. For example, both parties are freely entering this contract, and therefore are both given the right to leave it, given proper notice. However, while partaking in the contract, there are duties and obligations of each, which may neglect virtues of benevolence, care and compassion, which we do see stressed in other models.

Paternalism not so long ago was the model used in patient relations, it embodies two main ethical principles: beneficence—doing good- and non-maleficence—preventing harm. Dr. Fox could have prevented harm by considering the family’s wishes, and would have done

I will argue that it isn’t permissible to withhold information from Merry regarding her medical condition. First, I’ll begin discussing the autonomy and paternalism in the context of the doctor-patient relationship. Second, conceptual issues of ethical dilemma, soft and hard paternalism, and the proposed justification of its implications. Perhaps the strongest argument is how a patient should be treated when they are not acting fully rational.

First, disclosure of information to the patient will sometimes increase the likelihood of depression and physical deterioration, or result in the choice of medically inoptimal treatment. Second, disclosure of information is therefore sometimes likely to be detrimental to the patient’s health, and perhaps hasten his death. Third, health and prolonged life can be assumed to have priority among preferences for patients who place themselves under physicians’ care. Fourth, Worsening health or hastening death can therefore be assumed to be contrary to patients’ own true value orderings. Lastly, paternalism is therefore justified: doctor may sometimes override patients’ prima facie rights to information about their risks and treatments or about their own conditions in order to prevent harm (Vaughn, 96.)

In the US, the initial system concentrated on physician knowledge about an intervention and not the patient requirement, i.e., the physician was to decide the best practice as well as information to disclose to a patient. However, there was a recognizable trend towards the informed consent (Culhane et al., 2012). A case between Salgo and Leland Stanfors Jr. University Board of Trustees clearly provided a clear indication of the court resistance and struggle to adopt the autonomous approach rather than the physician paternalism (Culhane et al., 2012). The jury argued that the patient has the right to information of any risk associated with a practice. However, they argued for the physician in the sense that he/she is placed in a position to make choices that protect the patient.

Subsequently, paternalism is ethically controversial in medicine because it can potentially violate patient autonomy. Patient autonomy is important to respect and violation of this can have severe consequences. A patient that is mentally competent has the opportunity to make their own medical decisions. Paternalism is also ethically controversial because of the ethic of beneficence. This also leads to duty-ethics because physicians have the duty to use their best judgement is assisting their patients.