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Bioethics: SOC283
Lecture Two: Jan.13.2011
The right to self-governance (the ability to make your own decisions)
Case: Suppose you are a physician who specializes in treating mental illness. You have a
patient named John. John has been in and out of mental institutions within the past
couple of years, he has bi-polar disorders. He also suffers from some pretty serious
delusions, he claims himself to be the best scientist, he claims he is a wrestler, he claims
that he is in regular communication with the supernatural world; he also claims that he
is very good at doing physics. John becomes your patient because he has a history of
uttering death threats to peoplethis has gotten him in trouble with the law. He was
put on trial and it was determined that he is not criminally responsible due to his mental
illness. You look at his case, and you determine that over time his condition has been
getting worse; unless a serious type of treatment is taken. Hence if this doesnt occur
he cannot function external to the institution. You discover that there is a new
medication which has not been used before; however you think it might help him regain
his consciousness. You recommend the medication to John in order to help him
overcome the mental illness. Johns response is NO. What should be done in this type
of situation?
This case brings upon a great emphasis on the physician-patient relationships.
When thinking about the physician-patient relationships we need to consider
1. Goals of the physician-patient relationship
2.What are the duties/obligation of the physician?
3. What is the role of the patient’s values?
4. How do they conceive autonomy?
There are four models within the Physician-patient relationships:
Thinks of the relationship of the physician-patient, based on the same of a parent and child.
Takes on the belief that because a parent knows best, the physician knows best
The paternalistic model has goals which include:
a. Promoting the patients well being and health
b. Put the patients first (do what you think is best for the patient).
This goal claims that there are objective values which are being
promoted here.
An example of an objective value could be HEALTH.
Therefore, the objective value of health held within this model;
suggests that anything should be done in order to maintain health.
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Bioethics: SOC283
Lecture Two: Jan.13.2011
If the patient does not want health, then the physician must do what
is best for the patient, even if the patient does not want to accept it.
If this means that the doctor must put objective value first, then does this not mean that the
model does not promote autonomy of the patient?
This means that in the above case of JOHN, the medication should be given to john
even though he refuses. The reason why he is refusing is because he is confused
according to this model. Therefore, it is justifiable to override his decisions.
Limitations to this model:
1. There is no guarantee that the medication will work; hence how do we know it is
2. How do we know that health is of objective value?
What if health is not objectively valuable? What if it is subjective?
3. Health may be seen as valuable, but what about other values which exist such as
autonomy and creativity?
This means that the doctor is not entitled to assume that patients have the
same value of health as they do. We cannot assume that both physicians and
patients have the same objective value of health. (Fundamental Objection).
The goals of the informative model are as follows
a. The doctor should provide information, and then provide intervention based on what
the patient directs them to do.
b. The patient should have control over medical decision-making.
If the patient does not want to take the drugs then that is there choice.
The patient has a full range of autonomy within this model.
Limitations of the Model
a. What if someone wants to be the worlds fattest man? Does this mean that doctors
should give all information possible on how to attain this due in fact to the patient
wanting to do what they want to do?
b. What if the person is not capable to understand the information which is provided by
the doctor?
c. One worry about the informative model is that it only gives INFORMATION—not
actual advice.
D. The informative model asserts that your values are fixed, and that people understand
what they value in all circumstances. But this is not the case.
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