Models of the Doctor-Patient Relationship and the Ethics Committee: Part One

Abstract

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimes alters the nature of the ethical discussion. For example, if an institution predominately prides itself on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreneurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone. Ethics committees should not only be aware of the differences among models and their importance in decision making but should also contribute to an analysis of the value hierarchy occurring within cases and within the institution itself....Various models of the doctor-patient relationship will be introduced....I propose seven (although there are many more): paternalism, autonomy, entrepreneurial, contract, covenant, negotiation, and beneficence-in-trust. Each is examined for its strengths and weaknesses and the most likely values that will predominate within the relationship. These will be the values sought out for protection in any eventual resolution. In this first of two parts, I will look at the first three relationships and pose an initial discussion for a distinctive ethic for healthcare delivery.