I. Traditional conception of doctor-patient relationship A. The Hippocratic Oath 1. Hippocrates was a Greek physician, born about 460 B. C. , died around 377 B. C. , known as the Father of Medicine. 2. The Oath contains three elements: a. The Invocation: “I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and covenant: b. Two sets duties and prohibitions: i. Duties to the patient: ii.
Duties to other doctors: c. The Curse: “If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot. ”
3. Limitations of the Hyppocratic oath A. b. B. Other codes of medical ethics. American Medical Association codes prior to 1960. a. b. B. Paternalism Both the Hippocratic Oath and the American Medical association codes prior to 1960 are paternalistic. The principles of beneficence and nonmaleficence take priority over principle of autonomy. 1. The doctor is a quasi-parent a. Doctors are both skilled and wise b. Doctors always know best c. Doctors are experts in both medicine and morality.
d. To control doctors exercise over the patient is in the best interest of the patient 2. The patient is a quasi-child a. Patients are dependent b. Patients are incapable of understanding complex medical information c. Patients are incapable of making wise choices concerning their health d. It is in the best interest of the patient to be left out of the decision-making process . C. Changing attitude toward doctor-patient relationship Paternalism is slowly losing ground. Much of U. S. medical ehtics of the past forty years consists of a critique of paternalism and defense of patient rights.
The principle of autonomy has priority over the principle of beneficence. 1. Critique of paternalism. a. May conflict with autonomy b. Doctor and patients may disagree about the value about health and life in comparison with other values c. Doctors make mistake d. Many health care issues are not strictly medical. As a result, doctors are not necessarily better equipped then anyone else to make decision 2. Respect for patient autonomy a. Non-interference with patient’s choice b. Treating people as ends never merely as needs c. Help patients make their own decisions d. Think of patients as capable of making their own rational decisions.
3. What changed the attitude towards doctor-patient relationship? a. Doctor-patient relationship has become impersonal b. The growth of managed care c. Publicity surrounding health problems caused by medical intervention d. The growing perception that doctors at medical institution place their own financial interest ahead of their patient interest e. Abuse of medical research D. Alternative models of doctor-patient relationships The paternalistic model of doctor-patient relationship is obviously inadequate; patients ought to be treated in a way which respects their individuality and their capacity to
choose. What kind of relationship ought the doctor and the patient have? 1. Elements of doctor-patient relationship: 1. Question of authority to make decisions 2. The role of the caregiver, role of the caregiver to carry our moral and medical decisions 3. 4. What to do if the value of the doctor and those of the patient conflict 2. Robert Veatch’s models In an influential article “Models for Ethical Medicine in a Revolutionary Age”, Robert Veatch distinguished four models of docto-patient relationship a. Engineering model (Patients make all of the important decisions) i. ii.doctors should refrain from making value choices iii. the engineering model is built on a sharp distinction between facts and values B.
Priestly Model (Doctors make all of the important decisions) 1. 2. 3. 4. C. Collegial Model (Doctor and Patient share decisions) 1. doctor and patients are colleagues the share the same goal 2. 3. relationship is built on trust, it is personal D. Contractual Model 1. Doctor and patient enter into an agreement to pursue mutually accepted goals using mutually acceptable means 2. Patients make important decision but reserve the right to withdraw from the contract if the values of the patients conflict 3.
Doctors provide technical expertise and skills but reserve the right to withdraw from the contract if the values of the patients conflict 3. Assessment of Veatch’s models A. Engineering model 1. Strengths i. respects patient autonomy ii. it emphasizes doctors knowledge and expertise 2. Weaknesses i. doctors may be asked to do something in which they do not agree ii. B. Priestly model 1. Strengths i. 2. Weaknesses I. ii. C. Collegial model 1. Strengths i. ii. 2. Weaknesses i. ii. C. Contractual model 1. Strengths I. . ii. 2. Weaknesses i. ii.