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
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
• 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
• 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