ETHICAL MODELS OF PHYSICIAN – PATIENT RELATIONSHIP REVISITED WITH REGARD TO PATIENT AUTONOMY, VALUES AND PATIENT EDUCATION
Abstract
The present paper revisits the ethical models of patient – physician relationship from the perspective of patient autonomy and values. It seems that the four traditional models of physician – patient relationship proposed by Emanuel & Emanuel in 1992 closely link patient values and patient autonomy. On the other hand, their reinterpretation provided by Agarwal & Murinson twenty years later emphasizes the independent expression of values and autonomy in individual patients. Additionally, patient education has been assumed to join patient values and patient autonomy. Moreover, several authors have noted that, over the past few decades, patient autonomy has gradually replaced the paternalistic approach based on the premise that the physician knows what is best for the patient. Neither the paternalistic model of physician – patient relationship, nor the informative model is considered to be satisfactory, as the paternalistic model excludes patient values from decision making, while the informative model excludes physician values from decision making. However, the deliberative model of patient – physician interaction represents an adequate alternative to the two unsatisfactory approaches by promoting shared decision making between the physician and the patient. It has also been suggested that the deliberative model would be ideal for exercising patient autonomy in chronic care and that the ethical role of patient education would be to make the deliberative model applicable to chronic care. In this regard, studies have indicated that the use of decision support interventions might increase the deliberative capacity of chronic patients.
References
2. Warren R. Paternalism in medical ethics: a critique. Dialectic 2010; Issue 06.
3. Miller BL. Autonomy & the refusal of lifesaving treatment. Hastings Cent. Rep. 1981; 11(4): 22-28.
4. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA 1992; 267(16): 2221-2226.
5. Agarwal AK, Murinson BB. New dimensions in patient-physician interaction: values, autonomy, and medical information in the patient-centered clinical encounter. Rambam Maimonides Med. J. 2012; 3(3): e0017.
6. Entwistle VA et al. Supporting patient autonomy: the importance of clinician-patient relationships. J. Gen. Intern. Med. 2010; 25(7): 741-745.
7. Fallowfield LJ. Treatment decision-making in breast cancer: the patient-doctor relationship. Breast Cancer Res. Treat. 2008; 112 Suppl 1: 5-13.
8. Vulpoi C et al. Therapeutic patient education--method of optimizing treatment in chronic diseases. Rev. Med. Chir. Soc. Med. Nat. Iasi 2007; 111(1): 13-18.
9. Reach G. Patient autonomy in chronic care: solving a paradox. Patient Prefer. Adherence 2014; 8: 15-24.
10. Quill TE, Brody H. Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann. Intern. Med. 1996; 125(9): 763-769.
11. Nessa J, Malterud K. Tell me what's wrong with me: a discourse analysis approach to the concept of patient autonomy. J. Med. Ethics 1998; 24(6): 394-400.
12. Rosner F. Informing the patient about a fatal disease: from paternalism to autonomy--the Jewish view. Cancer Invest. 2004; 22(6): 949-953.
13. Brom L et al. Patients' preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients. PLoS One 2014; 9(6): e100435.
14. Roeland E et al. When open-ended questions don't work: the role of palliative paternalism in difficult medical decisions. J. Palliat. Med. 2014; 17(4): 415-420.
15. de Souza Trindade E et al. The physician when facing diagnosis and prognosis of advanced cancer. Rev. Assoc. Med. Bras. 2007; 53(1): 68-74.
16. Stiggelbout AM et al. Ideals of patient autonomy in clinical decision making: a study on the devel-opment of a scale to assess patients' and physicians' views. J. Med. Ethics 2004; 30(3): 268-274.
17. Weiss GB. Paternalism modernized. J. Med. Ethics 1985; 11(4): 184-187.
18. Pellegrino ED. Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship. J. Contemp. Health Law Policy 1994; 10: 47-68.
19. Woodward VM. Caring, patient autonomy and the stigma of paternalism. J. Adv. Nurs. 1998; 28(5): 1046-1052.
20. Gessert CE. The problem with autonomy. Minn. Med. 2008; 91(4): 40-42.
21. Chin JJ. Doctor-patient relationship: from medical paternalism to enhanced autonomy. Singapore Med. J. 2002; 43(3): 152-155.
22. Charles C et al. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc. Sci. Med. 1997; 44(5): 681-692.
23. Almyroudi A et al. Decision-making preferences and information needs among Greek breast cancer patients. Psychooncology 2011; 20(8): 871-879.
24. Peters E et al. Age differences in dual information-processing modes: implications for cancer decision making. Cancer 2008; 113(12 Suppl): 3556-3567.
25. O'Connor AM et al. Risk communication in practice: the contribution of decision aids. BMJ 2003; 327(7417): 736-740.
26. Barnato AE et al. Communication and decision making in cancer care: setting research priorities for decision support/patients' decision aids. Med. Decis. Making 2007; 27(5): 626-634.
27. Billings JA, Krakauer EL. On patient autonomy and physician responsibility in end-of-life care. Arch. Intern. Med. 2011; 171(9): 849-853.
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