Relationships in medical ethics

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This is a lecture for a medical ethics course that I am teaching at BGSU. The topic of this lecture is relevant relationships in medicine, and how they bear on medical ethics

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Relationships in medical ethics

  1. 1. Relationships in Medical Ethics<br />Medical Ethics-Online<br />Eli Weber, Instructor<br />Summer 2011<br />
  2. 2. Lecture Goals<br />Specify 3 distinct conceptions of the doctor- patient relationship<br />Consider whether patients have any obligations to their physicians<br />Discuss two approaches to the problem of truth-telling in medicine<br />Evaluate two different conceptions of the role of nurses<br />
  3. 3. Conceptions of the Doctor-Patient Relationship<br />The Doctor as Technician<br />Medicine is a value-free, objective science<br />Doctor provides all the relevant information, and lets the patient decide<br />The Doctor is Omniscient and Omnipotent<br />Physician alone can is qualified to evaluate relevant medical information<br />Patients should follow the recommendations of their physicians<br />
  4. 4. Conceptions of the Doctor-Patient Relationship<br />The Middle Way<br />A hybrid view, where the physician’s role is more nuanced than simply providing information, and the patient’s right to autonomy is seen as something that can be compromised in various ways. <br />
  5. 5. Physician’s Obligations<br />Confidentiality and Privacy<br />Veracity (truth-telling)<br />Respect for Autonomy<br />Fairness<br />
  6. 6. Patients’ Obligations?<br />Truth-telling<br />Compliance<br />Who Should Bear the Bulk of the Responsibility in this Relationship?<br />
  7. 7. Issue in Focus: Truth-Telling<br />The Problem: Should physicians always tell patients the truth about their condition and prognosis?<br />Goldman: The argument that physicians should sometimes withhold the truth from patients, for their own good, assumes that all patients value health and prolonged life over everything else. <br />
  8. 8. Issue in Focus: Truth-Telling<br />In fact, we know that people don’t value health and long life over everything else. We frequently sacrifice both for the sake of other good.<br />Further, being able to exercise our autonomy is valuable in its own right, and cannot be traded for gains in other values. <br />
  9. 9. Issue in Focus: Truth-Telling<br />Ackerman: Respect for autonomy, in the case of people with serious illnesses, is more than non-interference with choices. Illness negatively affects the patients’ ability to make truly autonomous choices. <br />Physicians, out of respect for patient autonomy, must sometimes intervene on the patients own behalf.<br />
  10. 10. Issue in Focus: Truth-Telling<br />Do Ackerman and Goldman disagree?<br />Goldman is opposed to strong paternalism in medicine, while Ackerman advocates interventions that restore autonomy. Can’t we do both?<br />If Ackerman is right, what exactly are physicians obligated to do?<br />
  11. 11. The Proper Role of Nurses<br />Newton: The nurse should be a subservient caregiver who lacks substantive authority over patient care.<br />-Hospital bureaucracies require clearly defined roles and command hierarchies<br />-In dangerous circumstances, the last thing that is needed is an additional autonomous agent<br />-The emotional needs of patients are such that they can only be met by a subservient, non-authoritative caregiver<br />
  12. 12. The Proper Role of Nurses<br />Kuhse: The subservient, non-autonomous nurse is likely to do more harm than good<br />-It is difficult to distinguish nurses from doctors, in terms of either their “essence,” their function, or their philosophical commitment.<br />-Even if physicians have a unique level of expertise, it doesn’t follow that nurses must always be subservient to physicians.<br />-Not all patients demonstrate the emotional needs that Newton discusses; the claim that nurses must be non-autonomous to meet these needs . <br />
  13. 13. The Bottom Line<br />The doctor-patient role is more nuanced than either the “technician” or the “omnipotent” conceptions suggest.<br />It seems physicians can avoid strong paternalism toward their patients without limiting themselves to the technician role.<br />It continues to be an open question whether the traditional role of the nurse, as subservient caregiver, is desirable.<br />

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