Four Models of the Doctor Patient Relationship PDF

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Details doctor-patient relationships and their various ethical domains in healthcare....

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Four Models of the Doctor Patient Relationship Goals: 1. Name and describe the 4 models of the doctor patient relationship 2. What are the three approaches to conscientious objection 3. What are two critiques peppin makes against the argument from PVN Four models of the doctor patient relationship 1. Paternalistic Model a. Doctor as guardian b. Health over autonomy c. Doctor knows best and should make decision d. Not much patient input e. Shift away from this has occurred f. Canterbury Case 1972 2. Informative Model a. Doctor as encyclopedia b. Autonomy over health c. Assumes patient knows what they want d. Lacks caring physician e. President’s counsel, this model is “too arid” f. Vending machine model of medicine 3. Interpretive Model a. Doctor as elucidator b. Sometimes patients don’t know what they want and the doctor can help them sort this out i. Patient may not have pre formed value about certain situations c. Doctor does not pass judgement on what the patient wants d. Asks questions to make the develop their own values without imposing values 4. Deliberative Model a. Doctor as deliberator b. Doctor presents options, helps clarify patient values, tries to persuade c. Doctor as a friend – shares personal values with patient and justifies them d. Doesn’t this just morph back into paternalism?  The politics of practice o Democratic physicians:  less likely to discuss legal details or health risks of marijuana use  More likely to advise against keeping guns in home  Pediatricians, psychiatrists, infectious disease specialists o Republican Physician:  More likely to advise on gun safety  More likely to discuss mental health consequences of abortion and encourage patient to seek counseling  60% of surgeons, anesthesiologists, urologists, and ENTs

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Different situate=ions call for different models o Paternalism for emergencies o Informative best for walk in, one time sessions, no previous relationships o Interpretive for highly controversial issues or issues where patient is torn about what to do o Deliberative for practices that are uncontroversially bad fir patient (smoking)

Conscientious Objection  Definition: legitimate claims of conscience must be grounded in religious or moral principles that compromise and individual’s core values, the violation of which is likely to result in intense shame, guilt, or loss of self respect  Two kinds of conscience objections o Against types of people o Against certain procedures  What if certain procedures are only sought by a certain group of people  Three approaches: o Incompatibility thesis  No test for whether or not an objection is sincerely held conscience clauses basically open the door for anyone to object to performing any part of their job  Where objections are sincerely held, this only amounts to doctors selfishly elevating their personal values over their professional obligation to provide care for patients  Providers may form conscience monopolies that create significant barriers for those seeking the services  Prince Edward island in Canada requires women to leave the province to receive an abortion  70% of Italian gynecologists object to abortions leading to a high level of “backstreet abortions”  “if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors” – Savulescu o Conscience absolutism  Health care professionals do NOT have an obligation to perform any action, including disclosure and referral, that is contrary to their conscience  “we are called to be Christians first, and physicians second” – John peppin  Peppin critiques the compromise for relying on a bad argument for its justification o Compromise  One may step away but not between  Traditional compromise  Conscientious objection is Not permitted in emergencies

Disclosure (in unbiased form) o Must give patient all the options  Referral - must tell patient where they can get the procedure done and refer them there if needed for insurance purposes  Physician Value Neutrality  No value is more correct than any other value  Physicians are able to be value neutral  Value neutrality by physician allows the patient ot pursue their own values  Allowing patients to pursue their own values is good  One should work to chieve the good  Therefore, physicians should be value neutral (informative/interpretive model)  CRITIQUES: o physicians cannot be entirely value neutral  Body language communicates unspoken values  Way we frame option influences patients  White coat syndrome o Internal inconsistency: by talking about something good you have made a value judgement  States no value is better than another yet asserts that allowing people to pursue their own values is itself a value The ethics of objection o Who should be allowed to object  Religious vs moral objection  Proximity to procedure – are you actually performing it  Positive or negative claims  Positive: I have a conscience that says I must provide a legal procedure that I know how to do o Performing emergency abortion in a catholic hospital  Negative: not doing something o To what procedures  People vs procedures o In what situations Inconsistent Defense of Conscience o Physician A refuses to give emergency contraception to a rape victim but works at a hospital committed to delivering all legal contraception o Physician B works at a hospital opposed to contraception but wants to provide contraception o Physician A can object, physician b would be fired 

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