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Ch 4 Veatch Physician Patient


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Ch 4 Veatch Physician Patient

  1. 1. “ Models for Ethical Medicine in a Revolutionary Age”: Robert M. Veatch <ul><li>What is the proper way to conceive of the doctor-patient relationship? </li></ul><ul><li>4 Models: Engineering, Priestly, Collegial and Contractual </li></ul><ul><li>Veatch ultimately endorses the Contractual Model </li></ul>
  2. 2. Engineering Model <ul><li>Obligation of the doctor is to provide the patient with all the relevant information; for the patient to select the medical intervention; and for the physician to execute the selected intervention. </li></ul><ul><li>Doctor is to remain objective – “He must be factual, divorcing himself from all consideration of value”(89) </li></ul>
  3. 3. Problems with the Engineering Model <ul><li>Promotes specialization and impersonalization within the medical profession </li></ul><ul><li>False assumption of a distinct demarcation between facts and values </li></ul><ul><li>Incorrectly presupposes patients have known and fixed values-no room for self-reflection and deliberation about values </li></ul><ul><li>“ Physician as plumber” model </li></ul>
  4. 4. Priestly Model <ul><li>Physicians ethical judgments are an essential aspect of the physician-patient relationship </li></ul><ul><li>Fundamental Moral Principle: “Benefit and do no harm” </li></ul><ul><li>“ It takes the locus of decision making away from the patient and places it in the hands of the professional”(89) </li></ul>
  5. 5. Problems with the Priestly Model <ul><li>“ Speaking-as-a” syndrome </li></ul><ul><li>Parent-child image of the physician-patient relationship </li></ul><ul><li>Minimizes other morally relevant principles found in balanced ethical systems </li></ul>
  6. 6. Moral Norms <ul><li>Beneficence (to do or produce good) </li></ul><ul><li>Non-malefeasance (do not harm) </li></ul><ul><li>Individual Freedom – essential to being truly human </li></ul><ul><li>Preserving Individual Dignity-the maintenance of freedom of choice and control over one’s life and body </li></ul><ul><li>Truth Telling and Promise Keeping-ignoring these can pose a threat to trust and confidence in the physician-patient relationship </li></ul><ul><li>Maintaining and Restoring Justice-there must be an insistence on a fair distribution of health care resources </li></ul>
  7. 7. Collegial Model <ul><li>Considered a balance between the Engineering and Priestly Models </li></ul><ul><li>Colleagues pursing a common goal of eliminating illness and preserving health </li></ul><ul><li>Based on trust and confidence between physician and patient </li></ul><ul><li>Equality of dignity, respect, and value contributions </li></ul>
  8. 8. Problems with the Collegial Model <ul><li>Is it realistic to believe that mutual loyalty and common goals exist in the physician-patient relationship? </li></ul><ul><li>Ethnic, class, and economic differences </li></ul><ul><li>Is there any real sense in which physician and patient are “equal” </li></ul>
  9. 9. Contractual Model <ul><li>Not to be viewed in overly legalistic terms </li></ul><ul><li>Contract/covenant in the tradition of a marriage </li></ul><ul><li>Maintains the basic norms: freedom, dignity, truth telling, promise keeping and justice. </li></ul><ul><li>Obligations and expected benefits are understood by both parties. </li></ul>
  10. 10. Advantages of the Contractual Model <ul><li>Avoids the “abdication” of responsibility found in the Engineering Model </li></ul><ul><li>Avoids the moral abdication of the patient found in the Priestly Model </li></ul><ul><li>Avoids the false sense of equality found in the Collegial Model </li></ul><ul><li>“ With the contractual model there is a sharing in which the patient has legitimate grounds for trusting that once the basic value framework for medical decision making is established on the basis of the patient’s own values. . .”(91) </li></ul>