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
2. Lecture Goals Specify 3 distinct conceptions of the doctor- patient relationship Consider whether patients have any obligations to their physicians Discuss two approaches to the problem of truth-telling in medicine Evaluate two different conceptions of the role of nurses
3. Conceptions of the Doctor-Patient Relationship The Doctor as Technician Medicine is a value-free, objective science Doctor provides all the relevant information, and lets the patient decide The Doctor is Omniscient and Omnipotent Physician alone can is qualified to evaluate relevant medical information Patients should follow the recommendations of their physicians
4. Conceptions of the Doctor-Patient Relationship The Middle Way 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.
7. Issue in Focus: Truth-Telling The Problem: Should physicians always tell patients the truth about their condition and prognosis? 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.
8. Issue in Focus: Truth-Telling 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. Further, being able to exercise our autonomy is valuable in its own right, and cannot be traded for gains in other values.
9. Issue in Focus: Truth-Telling 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. Physicians, out of respect for patient autonomy, must sometimes intervene on the patients own behalf.
10. Issue in Focus: Truth-Telling Do Ackerman and Goldman disagree? Goldman is opposed to strong paternalism in medicine, while Ackerman advocates interventions that restore autonomy. Can’t we do both? If Ackerman is right, what exactly are physicians obligated to do?
11. The Proper Role of Nurses Newton: The nurse should be a subservient caregiver who lacks substantive authority over patient care. -Hospital bureaucracies require clearly defined roles and command hierarchies -In dangerous circumstances, the last thing that is needed is an additional autonomous agent -The emotional needs of patients are such that they can only be met by a subservient, non-authoritative caregiver
12. The Proper Role of Nurses Kuhse: The subservient, non-autonomous nurse is likely to do more harm than good -It is difficult to distinguish nurses from doctors, in terms of either their “essence,” their function, or their philosophical commitment. -Even if physicians have a unique level of expertise, it doesn’t follow that nurses must always be subservient to physicians. -Not all patients demonstrate the emotional needs that Newton discusses; the claim that nurses must be non-autonomous to meet these needs .
13. The Bottom Line The doctor-patient role is more nuanced than either the “technician” or the “omnipotent” conceptions suggest. It seems physicians can avoid strong paternalism toward their patients without limiting themselves to the technician role. It continues to be an open question whether the traditional role of the nurse, as subservient caregiver, is desirable.
