In this eye-opening look at the doctor-patient decision-making process, physician and law professor Jay Katz examines the time-honored belief in the virtue of silent care and patient compliance. Historically, the doctor-patient relationship has been based on a one-way trust -- despite recent judicial attempts to give patients a greater voice through the doctrine of informed consent. Katz criticizes doctors for encouraging patients to relinquish their autonomy, and demonstrates the detrimental effect their silence has on good patient care. (...) Seeing a growing need in this age of medical science and sophisticated technology for more honest and complete communication between physician and patients, he advocates a new, informed dialogue that respects the rights and needs of both sides. In a new foreword to this edition of The Silent World of Doctor and Patient , Alexander Morgan Capron outlines the changes in medical ethics practice that have occurred since the book was first published in 1984, paying particular attention to the hotly debated issues of physician-assisted suicide and informed consent in managed care. (shrink)

Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue that doctor and (...) patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD. (shrink)

Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle’s practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. (...) Some difficulties and criticisms of this ontological model are also examined. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in (...) a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

Doctor/patient sexual contact has become a focal ethical issue of the 1990s. Guidelines or codes of ethics have been issued by various Medical Boards, prohibiting or regulating such conduct In some jurisdictions in Australia and elsewhere, such conduct has been deemed an offence under certain conditions. Mandatory reporting provisions may also apply. A clear profile of offending doctors and their areas of specialisation is emerging from various studies. The patient profile is less clear. The potential for harm to both (...) the patient and the offending doctor is an issue of concern, as is the apparently ineffective role of education in changing some doctor’s behaviour. The issue of sexual contact with former patients remains a grey area. (shrink)

This study explores the amount of control patients have versus the amount of control physicians have in making decisions regarding what course will be taken in the face of disease. This includes decisions about aggressive treatment, alternatives to aggressive treatment, hospice care, and possibly physician‐assisted death, if that is an option. The findings of this research conclude that there are many levels of control for physicians and patients, and that in certain cases patients may have limited control (...) and in other circumstances patients are entirely in control over their healthcare decisions. The personalities and education levels of both the physicians and the patients determine what kinds of options and control a patient will have. (shrink)

This article reviews and comments on the five categories of arguments used to defend zero tolerance with regard to sexual contacts resulting from the physician-patient relationship as summarised by Cullen. In addition it puts forward a hypothesis—“fear of loss by third party”—as a psychological explanation for the collective insistence on a zero tolerance policy.

According to policy makers, telemedicine offers “huge opportunities to improve the quality and accessibility of health services.” It is defined as diagnosis, treatment, and monitoring, with doctors and patients separated by space but mediated through information and communication technologies. This mediation is explored through an ethnography of a U.K. teledermatology clinic. Diagnostic image transfer enables medicine at a distance, as patients are removed from knowledge generation by concentrating their identities into images. Yet that form of identity allows (...) images and the expert gaze to be brought into potentially lifesaving proximity. Following Latour’s thread, images must be captured and then mobilized to the knowledge base, where they must be stabilized into standard diagnoses, then combined with different images, waiting lists, skin lesions, dermatologists, paper records, and beds, so that ultimately, outcomes are produced. This huge task requires new knowledges and a widening of agency that, if unacknowledged, may see telemedicine projects continue to founder. (shrink)

For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship (...) from the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings. (shrink)

Patient autonomy is a fundamental principle in end of life decision making. However, its realisation may take a variety of forms. Discourse analysis was conducted in a qualitative interview study of 19 physicians. The physicians made use of three different discourses, each of which contained a specific understanding of patient autonomy and a physician’s proper activities in the context of end of life decision making.

Doctors’ strikes are legally permissible in the UK, with the situation differing in other countries. But are they morally permissible? Doug McConnell and Darren Mann have systematically attempted to dismiss the arguments for the moral impermissibility of doctors’ strikes and creatively attempted to provide further moral justification for them. Unfortunately for striking doctors, they fail to achieve this. Meanwhile, junior doctors’ strikes have continued in the UK through 2023 and have now extended into 2024. In this (...) response, which focuses on the UK situation and specifically junior doctors’ strikes in the National Health Service (NHS) in England, I will demonstrate a central problem with their arguments—namely that they underplay the harms caused by prolonged doctors’ strikes by ignoring the harms to patients with cancer. This weakens their conclusion that strikes are morally permissible in terms of the conditions and thresholds they set. I then provide a psychological critique of their justification for strikes in terms of the interests of the public. It follows that invoking the controversial concept of supererogatory action is ungrounded but also absurd when you consider time-critical cancer care. If those representing striking doctors wish to maintain a modicum of moral respectability, they should mitigate for patients with cancer and negotiate reasonably and with urgency. (shrink)

This paper provides an analysis of the way in which two foundational principles of medical ethics–the trusted doctor and patient autonomy–can be undermined by the use of machine learning (ML) algorithms and addresses its legal significance. This paper can be a guide to both health care providers and other stakeholders about how to anticipate and in some cases mitigate ethical conflicts caused by the use of ML in healthcare. It can also be read as a road map as to what (...) needs to be done to achieve an acceptable level of explainability in an ML algorithm when it is used in a healthcare context. (shrink)

Some doctors do enter into sexual relationships with patients. These relationships can be damaging to the patient involved. One response available to both individual doctors and to disciplinary bodies is to prohibit sexual contact between doctors and patients ("zero tolerance"). This paper considers five ways of arguing for a zero tolerance policy. The first rests on an empirical claim that such contact is almost always harmful to the patient involved. The second is based on a (...) "principles" approach while the third originates in "virtues" ethics. The fourth argues that zero tolerance is an "a priori" truth. These four attempt to establish that the behaviour is always wrong and ought, therefore, to be prohibited. The fifth argument is counterfactual. It claims a policy that allowed sexual contact would have unacceptable consequences. Given the responsibility of regulatory bodies to protect the public, zero tolerance is a natural policy to develop. (shrink)

There is an extensive ethical debate regarding the justifiability of doctors nudging towards healthy behaviour and better health-related choices. One line of argument in favour of nudging is based on empirical findings, according to which a healthy majority among the public support nudges. In this paper, we show, based on an experiment we conducted, that, in health-related choices, people’s ethical attitudes to nudging are strongly affected by the point of view from which the nudge is considered. Significant differences have (...) been found between doctors’ ethical attitude to clinical nudging and that of patients. We show how these differences weaken the argument for nudging from public support. Moreover, our findings raise concerns regarding doctors’ ability to nudge ethically according to their own standards, as they may underestimate the degree of harm medical nudges can cause to informed consent, doctor–patient trust and other important ethically relevant features of health-related choices. (shrink)

Advances in medicine have brought us the stethoscope, artificial kidneys, and computerized health records. They have also changed the doctor-patient relationship. This book explores how the technologies of medicine are created and how we respond to the problems and successes of their use. Stanley Joel Reiser, MD, walks us through the ways medical innovations exert their influence by discussing a number of selected technologies, including the X-ray, ultrasound, and respirator. Reiser creates a new understanding of thinking about how health care (...) is practiced in the United States and thereby suggests new methods to effectively meet the challenges of living with technological medicine. As healthcare reform continues to be an intensely debated topic in America, Technological Medicine shows us the pros and cons of applying technological solutions health and illness. (shrink)

The World Medical Association's Declaration of Helsinki offers guidelines to doctors engaged in biomedical research with human subjects. The fundamental distinction of the Declaration is between clinical research combined with professional care and non-clinical scientific research. If hospital patients are the experimental subjects, then the former research must be carried out by the patient's own doctor, whereas the latter research must not be; it must be carried out by other doctors. The relevance of the distinction between the (...) patient's own doctor and other doctors is challenged and an alternative conception of the patient-doctor relationship is drawn, together with an alternative justification, based on the work of Hans Jonas, of the use of patients in research. Finally, the political nature of the patient-doctor relationship is mentioned, and it is claimed that the alternative conception of this relationship developed in the paper is more in line with the ethical principles of the Hippocratic tradition. (shrink)

This article discusses the principle results of a case study relative to a medium-sized hospital in northern Italy (130 doctors, 190 nurses, 300 beds). The subjects of the investigation are the metaphors used in the construction of the doctor's professional identity and in the definition of his or her relationship with the patient. The research tool used was a narrative interview conducted on the 14 head physicians and 4 charge nurses. The frequent unwitting use of metaphors reveals that the (...) patient's subjectivity is taken for granted or even neglected. It may emerge only when the patient becomes a conflictual or juridical subject. (shrink)

BackgroundPatient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects (...) of patient-centred care among doctors in the Chinese public hospitals.MethodsA quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.ResultsIn total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes.ConclusionThe study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals. (shrink)

January 2018, the American College of Obstetrics and Gynecology issued a position statement opposing the punishment of women for self‐induced abortion. To those unfamiliar with emerging trends in abortion in the United States and worldwide, the need for the declaration might not be apparent. Several studies suggest that self‐induced abortion is on the rise in the United States. Simultaneously, prosecutions of pregnant women for behavior thought to harm the fetus are increasing. The ACOG statement responds to both trends by urging (...) doctors to honor the integrity and confidentiality inherent in the doctor‐patient relationship. Seen in the context of the larger battle over legal abortion, the statement has far broader implications. By acknowledging the role doctors play in enforcing pregnancy‐related crimes, the ACOG position statement wisely anticipates the ways in which doctors will be implicated should access to legal abortion be further restricted. To understand the need for the ACOG directive, you must first understand that the story of what will happen if abortion becomes a crime in the United States is not to be found in history books; it is staring at us across our southern border. (shrink)

Nurses need to adapt to various interactional situations and design their talk for different recipients. One essential communicative task for nurses is to transmit information on test and measurement results both to the patient and to the physician. This article examines how nurses design their talk on numerical values according to the recipient and the activity. The nurse can deliver the information either plainly through numbers or by formulating some type of qualitative description of the value. The data consist of (...) 7.5 hours of video-recorded interaction in a Finnish hospital. Using conversation analysis, we demonstrate how the institutional roles and the ongoing activity sequence affect how nurses formulate their talk. When nurses discuss results with their patients, they typically use qualitative descriptions, whereas when they talk with doctors, the typical turn involves numeric information. It will be demonstrated that nurses construct their professional identity involving both care and medical expertise through their linguistic-interactional choices. (shrink)

Filial obligation and its implications have been little-debated in ethics. The basis of informed consent in libertarian positions may be challenged by inclusion of others beyond the immediate doctorpatient relationship. Some of the literature arguing for and against filial duty, including feminist literature, is presented as a backdrop to the argument that a patient’s family, and further, his or her community, contains the source of a broader perspective regarding decisions concerning his or her medical treatment. Communitarian models allow for a (...) medical decision to be owned by some or all stakeholders in patient outcomes. Although such a position undoubtedly confronts traditional notions of autonomy, it offers an alternative that may positively impact the practice of medicine by providing a more holistic treatment context. New models premised on shared decision-making will be presented as frameworks that may provide a theoretical basis for greater physician input into medical decisions that impact a patient’s family members and in more global terms, his or her community. (shrink)

Joann Starr, a Roman Catholic nun, and Bruce Zawacki, a burn surgeon, met 22 years ago in the Los Angeles County, University of Southern California Burn Center in the roles of a patient and her physician struggling over issues of autonomy and informed consent. After recovery, she remained a nun and has become a patient advocate and doctoral candidate in bioethics. He remained a burn surgeon and has become a bioethics teacher and author. Although they live in distant locations, they (...) maintain their friendship and frequently discuss their shared experience. Recently they met to reflect on the events, lessons, and meanings of their original encounter. (shrink)

This paper discusses the key role medical regulators have in setting standards for doctors who use artificial intelligence (AI) in patient care. Given their mandate to protect public health and safety, it is incumbent on regulators to guide the profession on emerging and vexed areas of practice such as AI. However, formulating effective and robust guidance in a novel field is challenging particularly as regulators are navigating unfamiliar territory. As such, regulators themselves will need to understand what AI is (...) and to grapple with its ethical and practical challenges when doctors use AI in their care of patients. This paper will also argue that effective regulation of AI extends beyond devising guidance for the profession. It includes keeping abreast of developments in AI-based technology and considering the implications for regulation and the practice of medicine. On that note, medical regulators should encourage the profession to evaluate how AI may exacerbate existing issues in medicine and create unintended consequences so that doctors (and patients) are realistic about AI’s potential and pitfalls when it is used in health care delivery. (shrink)

Physicians’ fear of criminal prosecution for prescribing opioid analgesics is a major reason why many chronic pain patients are having an increasingly difficult time obtaining medically appropriate pain relief. In Ruan v. United States, 142 S. Ct. 2370 (2022), the Supreme Court unanimously vacated two federal convictions under the Controlled Substances Act. The Court held that the government must prove that the defendant knowingly or intentionally acted in an unauthorized manner.

Bioethics is a subject far removed from the Chinese, even from many Chinese medical students and medical professionals. In-depth interviews with eighteen physicians, patients, and family members provided a deeper understanding of bioethical practices in contemporary China, especially with regard to the doctor-patient relationship (DPR) and informed consent. The Chinese model of doctor-family-patient relationship (DFPR), instead of DPR, is taken to reflect Chinese Confucian cultural commitments. An examination of the history of Chinese culture and the profession of medicine in (...) China is used to disclose the deep roots of these commitments. The author predicts that the DFPR model will further develop in China but that it will maintain its Chinese character. (shrink)

The latest book is a timely application of the Pragma-Dialectical argumentative approach to medical consultation. The book consists of six chapters, which are concerned with topics pertaining to resolving differences of the opinion in doctor-patient interaction. With the publication of the book, the authors have made new contributions to the field of doctor-patient argumentative discourse.

Some of the human relations of doctor and patient, by D.L. Edsall.--The care of patients. Its psychological aspects, by C.F. Martin.--The medical education of Jones, by Smith, by W.S. Thayer.--The significance of illness, by A.F. Riggs.--Some psychological observations by the surgeon, by F. G. Balch.--Human nature and its reaction to suffering, by L.K. Lunt.--The care of the aged, by A. Worcester.--The care of the dying, by A. Worcester.--Attention to personality in sex hygiene, by A. Worcester.

Every person in the course of his or her life has some contact with the medical profession. And in recent years that profession has been revolutionised in the fields of research, of technology and of practice. Hardly has one advance been declared than it is superseded by another. At the same time, while community attitudes themselves change, group practices have taken some weight from doctors but perhaps have diminished the doctor/ patient relationship of previous years. Another change in the (...) oversight of the medical profession has been the growth of what is called medical ethics. What, for example, is the amount of information a doctor should give a patient prior to performing an experimental procedure? Amongst all these changes there are still fundamental issues where doctors have to use their personal judgment as to what to do or what to say. For Max Griffiths this is where ethical considerations become matters of medical morality. He outlines a broad range of situations which frequently confront both doctor and patient, requiring sympathetic understanding on each side. Some of these arise out of the radical changes which have occurred in community attitudes and practices. Abortion and euthanasia are two important examples. Others range from growing pains and teenage trauma to ageing and dealing with dying and with loss. From his extensive associations with patients in a wide variety of situations the author tackles those issues which demonstrate what makes a good doctor. The result is a book that is for doctors and patients alike. Max Griffiths' involvement in medical matters range from responsibility for outback hospitals in places like Birdsville, Oodnadatta, Halls Creek and Fitzroy Crossing to long term membership of the board of the Austin Hospital in Melbourne. In this latter capacity he chaired committees responsible for the oversight of medical research, especially the protection of patients' rights. He was also involved in similar committees at the Royal Children's Hospital in Melbourne and the Royal Darwin Hospital. As a long term minister of religion his visits to his parishioners both at home and in hospitals gave him a deep insight into their anxieties. He was also a foundation member of Ronald McDonald House and chairman of several institutions engaged in the care of children with disabilities. [Subject: Sociology, Health Care, Medical Ethics]. (shrink)

This volume of papers is the long-awaited result of written contributions made by participants attending the conference entitled The Patient – Examining Realities, 5th Global Conference, held at Mansfield College, Oxford University, England, September, 2016. The conference organised by the multi-disciplinary academic forum Interdisciplinary Net attracted scholars and medical practitioners from across the world and became an intense three- day opportunity for fruitful discussion between professionals representing a number of disciplines: health and medical science, applied science such as occupational therapy, (...) counselling practices, more abstract and spiritual healing practices through symbolic intervention – with, e.g., mandalas opening up an emotional and much needed dialogue between doctor and patient and encouraging patients also to engage in their own healing process – film and media studies, literature, etc. This book sheds light on research conducted by some of these conference participants – most of them medical professionals and healthcare providers employed by reputable academic institutions and who take a both scientific and practical interest in the healthcare industry and its practices. The book also includes discourses by academics with a more theoretical interest in health and spirituality and the often complex, even problematic, doctor-patient relationship. Research presented in this volume of conference papers is both steeped in cultural traditions and reflective of new trends in certain countries across the globe. Theories, practices and trends highlighted in the book are ultimately universal in that they concern all of us on a global level. We will all at some stage become patients and are already patients, to a greater or lesser extent, throughout our lives. Given this, it feels vital to engage the reader in a discourse which highlights aspects of medical care that need to be brought to the fore and to the public attention, and to – both as readers and writers – also reflect on feelings and concerns expressed by patients themselves. This will hopefully lead to a greater understanding of what it means to be a patient and to increased levels of sympathy and empathy for what patients are going through. In saying this, the volume equally much highlights the role and significance of medical practitioners in times of increased patient rights and of pressing concerns, demands and expectations placed on the healthcare industry, at least in the Western world. (shrink)