Reconstituting the Doctor-Patient Relation

Abstract

The impact of illness on a person’s autonomy directly influences the individual’s ability to engage in the usual processes of discussion, advice, negotiation about values and consent. In previous chapters we articulated the way in which the clinical encounter can produce mutual slavery. This obstacle to autonomous decision-making, in turn, requires a different model of the doctor-patient relation than that functioning when the patient is fully competent. Since impediments to patient input run deeper than is often assumed, in many instances the model of the rational contract and negotiated values in the doctor-patient relation simply does not work. In fact, an examination of the impact of illness on persons might call into question the wisdom of establishing a goal of value negotiation even with competent patients in the state of serious illness when they are treated in tertiary care environments, as discussed in Chapter 5.

“Clinical interests lie not in the state of isolated cells but in the fate of a person.”

— World Medical Association (Gillon 1986)