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Ethical Dimensions of the Physician-Patient Relationship

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Geriatric Medicine

Abstract

The ethical aspects of the physician-patient relationship are shaped by such factors as the medical tasks at hand, the understanding or implicit contract between a physician and patient, the expectations that both physician and patient have of medical care, the social and institutional background of medical practice, and the personal and professional values that physicians and patients bring to the interaction. In this chapter, we will focus on four related aspects of the physician-patient relationship: 1) Autonomy and paternalism; 2) Truth-telling and disclosure; 3) Adherence to medical regimen; and 4) Problem patients. Underlying all four of these are questions about who should make decisions regarding therapy and whose evaluations of health, illness, and the quality of therapy should govern health care.

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References

  1. Beauchamp TL: Paternalism, in Reich WT (ed): Encyclopedia of Bioethics. New York, The Free Press, 1978, pp 1194 – 1201.

    Google Scholar 

  2. Childress J: Who Should Decide? Paternalism in Health Care. New York, Oxford University Press, 1982.

    Google Scholar 

  3. Pellegrino ED: Humanism and The Physician. Knoxville, University of Tennessee Press, 1979, p 120.

    Google Scholar 

  4. Thomasma DC: Beyond medical paternalism and patient autonomy: A model of physician conscience for the physician-patient relationship. Ann Int Med98: 243 – 248, 1983.

    PubMed  CAS  Google Scholar 

  5. Buchanan A: Medical paternalism, in Cohen M, Nagel T, Scanlon T (eds): Medicine and Moral Philosophy. Princeton, Princeton University Press, 1981, pp 214 – 234.

    Google Scholar 

  6. Locke J: The Second Treatise of Government. Indianapolis, The Bobbs-Merrill Co, Inc, 1952, pp 30 – 31.

    Google Scholar 

  7. Benjamin M, Curtis J: Ethics in Nursing. New York, Oxford University Press, 1981, pp 48 – 58, 75.

    Google Scholar 

  8. Freidson E: Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York, Dodd, Mead & Co, 1970, p 5.

    Google Scholar 

  9. Ladd J: Some reflections on authority and the nurse, in Spicker SF, Gadow S (eds): Nursing: Images and Ideals: Opening Dialogue With the Humanities. New York, Springer Publishing Co, 1980, pp 160 – 175.

    Google Scholar 

  10. Blumhagen DW: The doctor’s white coat: The image of the physician in modern America. Ann Int Med91: 111 – 116, 1979.

    PubMed  CAS  Google Scholar 

  11. Rosenfeld S: O’Banon v. Town Court Nursing Center: Patients’ right to participate in nursing home decertification. Am J Law Med7: 469 – 492, 1982.

    PubMed  CAS  Google Scholar 

  12. Veatch RM: Medical ethics: Professional or universal? Harvard Theolog Rev65: 531 – 559, 1972.

    Article  Google Scholar 

  13. Kant I: Foundations of the Metaphysics of Morals. Indianapolis, Bobbs-Merrill, 1959, pp 46–49, 66–67.

    Google Scholar 

  14. Mill JS: On Liberty. London, Fontana Library Edition, 1962.

    Google Scholar 

  15. Beauchamp TL, Childress JE: Principles of Biomedical Ethics. New York, Oxford University Press, 1979, p 56.

    Google Scholar 

  16. Miller BL: Autonomy and the refusal of life saving treatment, in Arras J, Hunt R (eds): Ethical Issues in Modern Medicine, ed 2. Palo Alto, Calif, Mayfield Publishing Co, 1983, pp 64 – 73.

    Google Scholar 

  17. Dworkin G: Autonomy and behavior control. The Hastings Center Report. 6: 23 – 28, 1976.

    Article  PubMed  CAS  Google Scholar 

  18. Schloendorff v. Society of New York Hospital, 211 NY 125; 105 NE 92 (1914).

    Google Scholar 

  19. Ehrenreich B, English D: Complaints and Disorders: The Sexual Politics of Sickness. Old West-bury, NY, The Feminist Press, 1973, pp 5 – 7, 23–25, 83.

    Google Scholar 

  20. Halper T: The double-edged sword: Paternalism as a policy in problems of aging. Milbank Mem Fund Quart/Health Soc58: 472 – 499, 1980.

    Article  CAS  Google Scholar 

  21. Capron AM: Informed consent in catastrophic disease research and treatment. University of Penn Law Rev123: 374 – 376, 1974.

    Google Scholar 

  22. Mendelson MA: Tender Loving Greed. New York, Random House, 1975.

    Google Scholar 

  23. Kayser-Jones JS: Old, Alone, and Neglected. Berkeley, University of California Press, 1981, p 129.

    Google Scholar 

  24. Kiefer CW: Lessons from the Issei, in Gubrium JF (ed): Late Life, Communities and Environmental Policy. Springfield, I11, Charles C Thomas Publisher, 1974, p 171.

    Google Scholar 

  25. Dowd JJ: Stratification Among the Aged. Monterey, Calif, Brooks/Cole Publishing Co, 1980, pp 73 – 75.

    Google Scholar 

  26. Mossey JM, Shapiro E: Self-rated health: A predictor of mortality among the elderly. Am J Publ Health72: 800 – 808, 1982.

    Article  CAS  Google Scholar 

  27. Motto JA: The right to suicide: A psychiatrist’s view, in Gorovitz S, et al (eds): Moral Problems in Medicine, ed 2. Englewood Cliffs, NJ, Prentice-Hall, 1983, pp 443 – 446.

    Google Scholar 

  28. Norberg A, Norberg B, Bexell G: Ethical problems in feeding patients with advanced dementia. Br Med J281: 847 – 848, 1980.

    Article  PubMed  CAS  Google Scholar 

  29. Norberg A, Norberg B, Gippert H, et al: Medical conflicts in long-term care of the aged: Nutritional problems and the patient-care worker relationship. Br Med J9: 377 – 378, Feb 1980.

    Article  Google Scholar 

  30. Bexell G, Norberg A, Norberg B: Ethical conflicts in long-term care of aged patients. Ethics Sci Med7: 141 – 145, 1980.

    CAS  Google Scholar 

  31. Christianson D: Aging and the aged: Ethical implications in aging, in Reich W (ed): Encyelopedia of Bioethics. New York, Macmillan Publishing Co, 1978, pp 58 – 65.

    Google Scholar 

  32. Butler RN: Why Survive? Being Old in America. New York, Harper & Row Publishers Inc, 1975, pp 300 – 320.

    Google Scholar 

  33. Rango N: Nursing-home care in the United States. N Engl J Med307: 886 – 887, 1982.

    Article  Google Scholar 

  34. Lau EE, Kosberg JI: Abuse of the elderly by informal care providers. Aging 299–230:10–15, 1979, Sept-Oct.

    Google Scholar 

  35. Cross AW, Churchill LR: Ethical and cultural dimensions of informed consent. Ann Int Med96: 110 – 113, 1982.

    PubMed  CAS  Google Scholar 

  36. American Hospital Association: A patient’s bill of rights, in Jameton A: Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ, Prentice- Hall, Inc, 1984, pp 316 – 317.

    Google Scholar 

  37. Kübler-Ross E: On Death and Dying. New York, Macmillan Publishing Co, 1969, pp 25 – 33.

    Google Scholar 

  38. Oken D: What to tell cancer patients: A study of medical attitudes. JAMA175: 86 – 94, 1961.

    Google Scholar 

  39. Novack DH, et al: Changes in physicians’ attitudes toward telling the cancer patient. JAMA241: 897 – 900, 1979.

    Article  PubMed  CAS  Google Scholar 

  40. Appleton WS: The importance of psychiatrists’ telling patients the truth, in Gorovitz S, et al (eds): Moral Problems in Medicine, ed 2. Englewood Cliffs, NJ, Prentice-Hall, 1983, pp 214 – 217.

    Google Scholar 

  41. Hackett TP, Cassem NH, Wishnie HA: The coronary-care unit: An appraisal of its psychologic hazards. N Engl J Med279: 1365 – 1369, 1968.

    Article  PubMed  CAS  Google Scholar 

  42. Derogatis LR, Abeloff MD, Melisaratos N: Psychological coping mechanisms and survival time in metastatic breast cancer. JAMA 242: 1504 – 1508, 1979.

    Article  PubMed  CAS  Google Scholar 

  43. Brody H: The lie that heals: The ethics of giving placebos. Ann Int Med97: 112 – 118, 1982.

    PubMed  CAS  Google Scholar 

  44. Silverman M, Lee PR: Pills, Profits, and Politics. Berkeley, University of California Press, 1974.

    Google Scholar 

  45. Coulter HL: Drug industry and medicine, in Reich WT (ed): Encyclopedia of Bioethics. New York, The Free Press, 1978, pp 320 – 326.

    Google Scholar 

  46. Roberts AW, Visconti JA: The rational and irrational use of systemic antimicrobial drugs. Am J Hosp Pharm29: 828 – 834, 1972.

    PubMed  CAS  Google Scholar 

  47. Silverman M: The Drugging of the Americas. Berkeley, University of California Press, 1976.

    Google Scholar 

  48. Blackwell B: Drug therapy: Patient compliance. N Engl J Med289: 249 – 252, 1973.

    Article  PubMed  CAS  Google Scholar 

  49. Bourne H: Unrecognized therapeutic measures, including placebo, in Melmon KL, Morelli HF (eds): Clinical Pharmacology: Basic Principles in Therapeutics, New York, Macmillan Publishing Co, 1972, pp 559 – 560.

    Google Scholar 

  50. Shapiro AK: The placebo effect in the history of medical treatment: Implications for psychiatry. Am J Psychiatry116: 298 – 304, 1959.

    PubMed  CAS  Google Scholar 

  51. Goodwin JS, Goodwin JM, Vogel AV: Knowledge and use of placebos by house officers and nurses. Ann Int Med91: 106 – 110, 1979.

    PubMed  CAS  Google Scholar 

  52. Cassel C, Jameton AL: Power of the placebo: A dialogue on principles and practice. The Art of Medication1: 21 – 27, 1980.

    Google Scholar 

  53. Jonsen AR: Ethical issues in compliance, in Haynes RB, Taylor DW, Sackett DL (eds): Compliance in Health Care. Baltimore, Johns Hopkins University Press, 1979.

    Google Scholar 

  54. Peterson CJ: The new nurse and the new physician. Ann Int Med96: 374 – 375, 1982.

    Google Scholar 

  55. Mechanic D, Aiken LH: A cooperative agenda for medicine and nursing. N Engl J Med307: 747 – 750, 1982.

    Article  PubMed  CAS  Google Scholar 

  56. Berg G, Gadow S: Toward more human meanings of aging: Ideals and images from philosophy and art, in Spicker SF, Woodward KL, van Tassel DD (eds): Aging and the Elderly: Humanistic Perspectives in Gerontology. Atlantic Highlands, NJ, Humanities Press, 1978, pp 83 – 92.

    Google Scholar 

  57. George V, Dundes A: The gomer: A figure of American hospital folk speech. J Am Folklore91: 568 – 581, 1978.

    Article  Google Scholar 

  58. Goodwin J, Kellner R: Psychiatric symptoms in disliked mental patients. JAMA241: 1117 – 1120, 1979.

    Article  PubMed  CAS  Google Scholar 

  59. Groves J: Taking care of the hateful patient. N Engl J Med298: 883 – 887, 1978.

    Article  PubMed  CAS  Google Scholar 

  60. Hardison JE: The importance of being interesting. Am J Med68: 9 – 10, 1980.

    Article  PubMed  CAS  Google Scholar 

  61. Papper S: The undesirable patient. J Chron Dis22: 777 – 779, 1970.

    Article  PubMed  CAS  Google Scholar 

  62. Reiss R: Moral and ethical issues in geriatric surgery. J Med Ethics6: 71 – 77, 1980.

    Article  PubMed  CAS  Google Scholar 

  63. Gadow S: Medicine, ethics, and the elderly. The Gerontologist20: 680 – 685, 1980.

    Article  PubMed  CAS  Google Scholar 

  64. Gruman GJ: Cultural origins of present-day “age-ism”: The modernization of the life cycle, in Spicker SF, Woodward KL, van Tassel DD (eds): Aging and the Elderly: Humanistic Perspectives in Gerontology. Atlantic Highlands, NJ, Humanities Press, 1978, pp 359 – 387.

    Google Scholar 

  65. Ouslander JG, Kane RL, Abrass IB: Urinary in-continence in elderly nursing home patients. JAMA 248: 1194 – 1198, 1982.

    Article  PubMed  CAS  Google Scholar 

  66. Cassell EJ: Dying in a technological society, in Steinfels P, Veatch RM (eds): Death Inside Out. New York, Harper & Row Publishers Inc, 1975, pp 43 – 48.

    Google Scholar 

  67. Hauerwas S: Reflections on suffering, death and medicine. Ethics Sci Med6: 229 – 237, 1979.

    PubMed  CAS  Google Scholar 

  68. Strain JJ: Agism in the medical profession. Geriatrics36: 158 – 165, 1981.

    PubMed  CAS  Google Scholar 

  69. Outka G: Social justice and equal access to health care. Perspect Biol Med18: 185 – 203, 1975.

    PubMed  CAS  Google Scholar 

  70. Winslow GR: Triage and Justice. Berkeley, University of California Press, 1982, pp 124 – 126.

    Google Scholar 

  71. Petrie LM, Lawson EC, Hollender MH: Violence in geriatric patients. JAMA248: 443 – 444, 1982.

    Article  PubMed  CAS  Google Scholar 

  72. Butler RN: Why Survive? Being Old in America. New York, Harper & Row Publishers Inc, 1975, pp 198 – 200.

    Google Scholar 

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Authors
  1. Andrew Jameton Ph.D.
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Editor information

Editors and Affiliations

  1. Department of Geriatrics, Mt. Sinai Medical Center, 1 Gustave Levy Place, New York, New York, 10029, USA

    Christine K. Cassel M.D.

  2. Section of Geriatric Medicine, Veterans Administration Medical Center, Portland, Oregon, 97201, USA

    John Richard Walsh M.D.

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© 1984 Springer-Verlag New York, Inc.

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Jameton, A. (1984). Ethical Dimensions of the Physician-Patient Relationship. In: Cassel, C.K., Walsh, J.R. (eds) Geriatric Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-5232-0_11

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  • DOI: https://doi.org/10.1007/978-1-4612-5232-0_11

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-9749-9

  • Online ISBN: 978-1-4612-5232-0

  • eBook Packages: Springer Book Archive

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