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Lecture 10

PHI2396 Lecture 10.docx

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Devin Shaw

PHI2396 Lecture 10 October 2, 2013 • The healthcare professional – patient relationship borders on trust, no judgement and other factors that help foster a better relationship. • From the story of Scott Starson (2005), the complications of the doctor-patient relationship depends on the actions and cooperation of the two parties. Scott’s refusal of treatment on several basis including; the dependence of his creativity on his drug intake. • On the end of the doctor/healthcare provider, requirements for a ‘healthy’ doctor- patient relationship include; o Respect and dignity of patients. o Admitting the vulnerability of patients.  NOTE: Although these are patient views, the views/goals of the healthcare provider are also important in determining the relationship. These views include: • Healthcare provider to Consumer view – This view could describe that the relationship is a commercial venture with minimal ethical obligations. As Tauber says, it would seem the values of the marketplace are observed in greater proportions as opposed to the care-commitment drive. • The Engineering Model of Doctor-Patient Relationship o This model says ‘doctors should rely on the facts of medical practice and leave out their individual value judgements’. o It describes medicine as an applied science wherein similar situations should be approached with similar fact responses. • The Paternalistic Model o This model says ‘doctors can provide the prescribed healthcare based on self-judgement and patient is supposed to follow doctor’s decision’. o Using the paternal/maternal model of life, the doctors have the decision ‘hand’ because they know what’s best for the patient. o This model relieves the patient of their dignity and respect and leaves the power with the doctors. This would contradict a typical feminist ethical view. o It has 3 ‘flawed’ assumptions;  That the goals of medicine are clear, so that doctors know what’s best for patients.  That giving diagnosis and prognosis is an exact science.  That all physicians are competent and know what is in their patients’ best interests (68). • The Contractual Model o Acts as a median of the two above models. Recognizes the autonomy of the patient (ability to make decisions). Includes the doctor and patient in the decision-making process. o Its flaw however, is the fact that in the process of having autonomous control, the power of the doctor and the dignity and respect of the patient is forgotten. • The Covenantal Model o This model requires doctors to add ‘an extra layer of commitment’ to the relationship. Involves moving beyond the set rules, rights and duties of the medical profession. • Autonomy has to be included in ethical decision-making and as a means of human flourishing. Autonomy can be described as ‘self-rule’. o Has certain ethical limits. It might affect
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