Emerging ethical perspective in physician-patient relationship

Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i

The present paper revisits the ethical models of patient--physician relationship from the perspective of patient autonomy and values. It seems that the four traditional models of physician--patient relationship proposed by Emanuel & Emanuel in 1992 closely link patient values and patient autonomy. On the other hand, their reinterpretation provided by Agarwal & Murinson twenty years later emphasizes the independent expression of values and autonomy in individual patients. Additionally, patient education has been assumed to join patient values and patient autonomy. Moreover, several authors have noted that, over the past few decades, patient autonomy has gradually replaced the paternalistic approach based on the premise that the physician knows what is best for the patient. Neither the paternalistic model of physician-patient relationship, nor the informative model is considered to be satisfactory, as the paternalistic model excludes patient values from decision making, while the info...

Bangladesh Medical Journal, 2014

The "doctor-patient" relationship (DPR) or the "physician-patient" relationship (PPR) has long been recognized as a complex, multifaceted, and complicated balance of engagement between the care-seeker and the care-giver. The physician-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics. In the present moment doctor-patient relationship (DPR) or physician-patient relationship (PPR) is one of the major issues in health-care throughout the world. The most common complains about the physicians of Bangladesh is their attitude towards the patients. The patients must have confidence in the competence of doctors and should feel that they can confide in him or her. For physicians, the establishment of a good relationship with the patients is also important. In develope...

Singapore medical journal, 2002

For centuries, physicians have been allowed to interfere and overrule patient's preferences with the aim of securing patient benefit or preventing harm. With the radical rise in emphasis on individual control and freedom, medical paternalism no longer receives unquestioned acceptance by society as the dominant mode for decision-making in health care. But neither is a decision-making approach based on absolute patient autonomy a satisfactory one. A more ethical and effective approach is to enhance a patient's autonomy by advocating a medical beneficence that incorporates patients' values and perspectives. This can be achieved through a model for shared decision making, acknowledging that though the final choices reside ultimately in patients, only through physician beneficence can the patient be empowered to make meaningful decisions that serve them best. For such a model to function effectively, the restoration of trust in doctor-patient relationship and the adoption of ...

2020

Nowadays, the paradigm of ‘Listen to the Doctor’ is weakening in health-care-delivery. The higher expectation of health-care-delivery quality expectation, the better patient-best-preference, and the more complicated system in health-care-delivery, have led to the shift of the paradigm to ‘Listen to the Patient’. Ethically, these situations are enhancing the bargaining position of the patient based on the principle of respect for autonomy. The principles of ethics in health-care- delivery are very important as the proper ground to anticipate the possibilities of unethical behavior by the health-care-provider and caregiver. Those evolutions are also enhancing the efforts of improving the quality of medical human resources, up-to-date medical technology, novel medical researches, and efficient cost-benefit ratio, so that the patient’s health, safety, quality-of-life, and patient-best-preference, can be achieved on the highest level. The paradigm of ‘Listen to the Patient’, which is in ...

Medicine, health care, and philosophy, 2016

The fiduciary nature of the patient-physician relationship requires clinicians to act in the best interest of their patients. Patients are vulnerable due to their health status and lack of medical knowledge, which makes them dependent on the clinicians' expertise. Competent patients, however, may reject the recommendations of their physician, either refusing beneficial medical interventions or procedures based on their personal views that do not match the perceived medical indication. In some instances, the patients' refusal may jeopardize their health or life but also compromise the clinician's moral responsibility to promote the patient's best interests. In other words, health professionals have to deal with patients whose behavior and healthcare decisions seem counterproductive for their health, or even deteriorate it, because of lack of knowledge, bad habits or bias without being the patients' free voluntary choice. The moral dilemma centers on issues surroun...

Journal of the Ceylon College of Physicians, 2019

The Journal of Medical Humanities, 1994

Much distinctively American medical ethics in the last two decades has been conceptually framed in adversarial terms: patient versus physician. David J. Rothman partially explains this adversarial framework. If he is correct, the contemporary movement in medical ethics begins in 1966 with Henry Beecher's expose' of abusive human experimentation in the United States. I Certainly research on human subjects has shown physicians at their worst, leading to the conclusion that first and foremost, patients must be protected from their doctors. 2 No doubt in many eases patients need protections. More recently the adversarial fires have been fanned by the legal profession, whose writings on medicine and law are largely shaped by the only language that our tradition of 17th-century political-and legalphilosophical debates condones: individual rights over against society. Scholar attorney George Annas represents this approach in his "basic American Civil Liberties Union guide to patient rights. ''3 Patients do have rights, and the legalistic approach to the physician-patient relationship serves a purpose. Much of current philosophical medical ethics is formed in response to major legal decisions, and is shaped by a liberal individualistic philosophy of the self that emphasizes patient autonomy and rights. There is thus no serious treatment of nonadversarial themes, like trust and friendship in the physician-patient relationship, except to dismiss them as potentially paternalistic. For example, in his writing on the physician as "stranger," Robert Veatch indicates deep suspicion of classical friendship models. The modern healthcare system, he argues, treats the patient lCorrespondence should be directed to

Bioethics, 2002

Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that`doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patients from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at others ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair captivity of doctors as helpers.

Discover Medicine, 2024

The COVID-19 pandemic and its aftermath have amplified deep divisions and distrust in our society, with many patients continuing to express skepticism about and refusing vaccines and other health care recommendations from physicians. These circumstances have compounded already high levels of moral distress and burnout and intensified physicians' feelings of frustration, anger, and helplessness. Facing persistent distrust and distress, how can clinicians guard against disengagement and sustain their commitment to the patient's good? In response to this challenge, we consider how the patient-physician relationship might be reframed as an ethics of solidarity. We do so at the level of a person's 'calculus of consent'-i.e., the rationality of why and how a physician cares for or helps a patient. We argue that an ethics of solidarity can help to recontextualize the patient-physician interaction within a richer perception of the parties' shared social existence and better motivate a moral commitment to overcoming division and distrust.

Health Expectations, 1999

Whilst there is no consensus amongst analysts regarding how best to de®ne`patient empowerment', at the very least, this concept entails a re-distribution of power between patients and physicians. Empowered patients attempt to take charge of their own health and their interactions with health care professionals. Empowerment can occur at dierent levels (micro, meso, and macro) and patients have dierent ideas about what it means to`take charge' and`be empowered'. Some patients simply want to be given information about their conditions whilst others want to have full control over all medical decision-making. Some empirical evidence suggests that active patient participation in health care is associated with better patient outcomes. This ®eld is ripe for future studies which both help to develop theoretical models of patient empowerment and articulate the conditions under which patient empowerment occurs. manifestations at the macro-, micro-, and mesolevels of society. Thirdly, several key studies pertaining to patient empowerment as a particular type of patient role are reviewed. These studies were selected to articulate the breadth of ways in which the concept of patient empowerment has been operationalized in empirical work; they do not constitute a systematic literature review. The conclusion discusses the need for further research in this area.