Clinical Intuition: A Procedure for Balancing the Rights of Patients and the Responsibilities of Physicians

Abstract

The assumption underlying the subtitle of this paper is that medicine in the 1970’s has become an adversarial practice, requiring a procedure for adjudicating between the rights of patients and the responsibilities of physicians. It is ironic that the relationship between doctor and patient — traditionally a vital element in the healing process — should deteriorate at precisely the time when medicine has become more effective. Although the doctor-patient relationship appears to be evolving in a libertarian direction, emphasizing individual autonomy, self-determination, and rights, an ambivalence remains; witness the unclarity of attitude of the courts and legislatures. Precisely because this uncertainty exists, it is not surprising that at times the practice of medicine seems to juxtapose the interests of patients and those of physicians. This essay will consider these questions by examining two very different issues in modern medicine:

• (1) the rights of patients and the responsibilities of physicians in situations in which acutely, critically ill patients who have easily treatable diseases refuse life-saving therapy, and

• (2) the rights of patients and the responsibilities of physicians in situations in which ambulatory patients with self-defined senses of dis-ease or illness demand specific services from physicians.