PHI 2396 Lecture Notes - Paternalism

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4 Feb 2013
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Health Care Models
Engineering:
Doctor has so many years of experience so to ask for no bias is a shame. They are wiser and has more
information, better judgement because of being so much more informed and skilled then asked
actually not to use all of her background knowledge.
People are not facts, not objects as Kant would say they are subjects. To treat someone if you walked
in, announce diagnosis, run through treatment options and walk out the door is to treat someone not as
a person, just go through mechanical role of the basics. Almost ignoring there is a subject in there.
Contractual:
Patient and physician is seen as loose contract.
Both parties are not equal here.
Vague not clear of meeting point (overlap) between patient and physician is. What is the dynamic
(very unclear in textbook according to prof). Unspoken relationship between patient and physician
patient has role to listen, physician gives advice. Patient needs physician (more vulnerable), physician
needs patient (in a lesser sense)
Paternalistic:
Old school model of healthcare physician takes a parent role and patient doesn’t question patient
program.
Physician assumes responsibility because patient doesn’t know much about his/her own physiology
and understanding of the body. You can’t educate them with 5 years of medical knowledge to get them
to understand. Less than autonomous, it recognizes dependency. (They are specialists in this trait).
Physicians may deceive patients if it is in their best interest not tell them the severity if the full results
aren’t in. Little knowledge is dangerous (ex. We found something unusual in the left breast – without
sending results to lab for full clarification - gets people worried and fires up their anxiety). So maybe not
say anything till results come back.
It is a model that is less and less attractive!
Covenantal textbook sees it as the best
More ideal doctor patient relationship is seen as partnership - working together towards health.
Doctor is kind of a partner in patients development (moving through life in a way) the doctor is available
not only in illness and crisis but monitoring patients care through health. Decisions are based on
knowledge of patient’s character. Doctor and patient coordinate and collaborate the plan for medical
care. Doctor gets to know patient a bit through conversation and physician can now recommend an
appropriate treatment. Relationship is built up with doctor.
Nurse-patient relationship
Nurse is intermediate. Nurse is inclined to side with the doctor they are working under the doctor.
So even if patient has problem with doctor and wants to report to nurse nurse is inclined to side with
the doctor in terms of professional office relationship. Certain therapies, certain drugs cause certain
reactions and we can adjust illness/disease according to the mechanical cause and effect relationships.
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