The Physician as a Double Agent

Katz states, “the conviction that physicians should decide what is best for their patients, and, therefore, that the authority and power to do so should remain bested in them, continued to have deep hold on the practices of the medical profession “(214).

17. Pellegrino argues for a three-tiered system of obligations incumbent upon physicians. They are in ascending order of ethical sensitivity.

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?

“The only appropriate and realistic model of the Dr.‐patient relationship is paternalism. Doctors are the medical experts; most patients have little, if any, reliable medical knowledge; implicit trust in one’s physician is essential to the healing process; and doctors have the responsibility for our health and therefore have the duty to make all the important medical decisions.” Critically assess that claim.

Edmund Pellegrino’s account of virtue based ethics practiced by a physician reaches an extremely high moral standard and involves the expression, at the highest level, of benevolence, temperance, fidelity to trust, integrity, justice and compassion which goes over and above what is strictly required of a physician; whereas, legal and rights-based ethical conceptions involve a physician adhering to the duties imposed on them by the laws of the land-such as physician licensure, good Samaritan laws, anti-discrimination laws, etc., and medical ethics codes and duties which are more obligations and duties to what strict ethics spells out.

ii. Unconscious physician bias. Another theme in the reading that related back to class was the unconscious biases of doctors influence their interactions with patients, with consequences for patient outcomes. These unconscious biases affect interaction through the doctor’s communication. Establishing a basic understanding of treatment and diagnosis can foster better patient outcomes. An example of unconscious physician bias was Abraham 's focus on former secretary of the Department of Health and Human Services, Dr. Sullivan, in chapter eight. Dr. Sullivan’s campaign focused on the individual choice in adopting healthy lifestyle choices from diet to exercise. Skipping over racial disparities, the unconscious bias inferred through his words was that he considered the patient to blame whenever they fell ill.

It also goes against the requirement of a medical committee member to promote education regarding medical ethical matters and also to assess and provide patient care by demonstrating a respect for patient rights. However, despite Dr. McKeen’s callous attitude towards his patients, I believe he would follow the principle of beneficence, a supporting theory about the value of avoiding harm and helping others. Although he treated his patients in a lackadaisical manner, he demonstrated his gifted surgical abilities with the ultimate goal to heal them. Even when he is diagnosed with cancer and scheduled to receive radiation therapy, he’s concerned about missing his scheduled surgeries and continues to go to work despite his sickness.

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.)

Historically, physicians are more respected by the public’s dependence on their expertise more so than their experience with social and policy issues. Take for instance; physicians are already advocates for their patients’ health. Patients benefit from not only a physician’s professional medical advice, but also, when it comes to trying to get insurance approvals, often times the physician will be of a support. Overall, physicians play a huge role in patients’ healthcare for not only servicing them, but educating them as well. There is a constant communication with the patient-physician relationship. But even with a strong patient-physician relationship it is the social determinants

First, when physicians place their self-interests ahead of their patients, they are creating an environment in which patient’s concerns are inferior to their own. This can severely damage the physician-patient relationship. In a study researchers found that hypertension patients became “non-compliant” when they believed their physician was unconcerned (Jin & Sklar, 2014). Additionally, many studies have addressed the need

Many physicians feels and demontrates frustration on the changes and lost control of the practice of medicine to business interests. Accustomed to having the authority to make decisisons about the best care for their patients, they are now questioned and scrutized on the treatments they provide for and care for their patients.

For the most part, physicians make every effort to work ethically, deliver high-quality medical care to their patients and send relevant claims for disbursement. The general public put their trust in physicians to do the moral thing. The patients depend on physicians to use their expertise to put them on the road to recovery when their health is most vulnerable. The federal government and other third-party payers also rely on physician’s medical decisions to treat and provide services that appropriate for the services that rendered. When the physicians and other medical related facilities submit claims the government expects them to submit physicians and hospitals reimbursing claims for services provided to program recipients, the federal government relies on physicians to submit correct and legitimate claims. The medical providers that are deceitful and exploit the health care system for unlawful purposes have formed the need for laws that combat fraud, abuse and guarantee high-quality medical care.

This case study is a prime example of a physician abusing his power. To take advantage of a patient displays a lack of ethical and moral values. The case provided involves a physician that is the defendant and the plaintiff who was his patient a 51 year old woman. The plaintiff stated having marital problems early on in treatment, and was also seeking help for problems with communication, family issues and codependency. It was up to this physician to provide her with the care she needed, but instead he carried out a relationship with the patient causing her more emotional anguish.

The doctor-patient relationship always has been and will remain an essential basis of care, in which high quality information is gathered and procedures are made as well as provided. This relationship is a critical foundation to medical ethics that all doctors should attempt to follow and live by. Patients must also have confidence in their physicians to trust the solutions and work around created to counter act certain illnesses and disease. Doctor-patient relationships can directly be observed in both the stories and poems of Dr. William Carlos Williams as well as in the clinical tales of Dr. Oliver Sacks. Both of these doctors have very similar and diverse relationships with multiple patients

Imagine you are injured or sick and have sought a doctor’s help. Although you trusted your doctor, something, something seemingly very in control of the doctor, went wrong. You are angry and confused, but also think of the commonality of medical malpractice. So, why do doctors, who are supposed to help, harm? Though many flaws influence it, malpractice can be, and often is unintentional. Most doctors aren’t trained to harm their patients. Inexperience and lack of medical discovery led to unintentional suffering of the patient. Personal flaws, like lack of willingness to abandon previous medical methods and shortcomings in communication also harm patients. Further reasons why doctors harm are socio-medical understandings that breed hate, prejudices stemming from a society’s belief about certain people, such as the medical practice under the Nazi regime. Additionally, displayed in the case of Ignác Semmelweis, judgement of one to oneself can be detrimental to any progress one’s ideas could make. We will examine these concepts through Jerome Groopman’s “Flesh-and-Blood Decision Making”, Sherwin Nuland’s The Doctors’ Plague and Barbara Bachrach’s “In the Name of Public Health”. Those who practice medicine are, unfortunately, unfree from the imperfections that plague all of humanity. Through these intimate and varied faults, doctors do harm.