Reconciling Values in the Contemporary Doctor-Patient Relationship

Fidelity to Patient Welfare

It is widely recognized that when patients are competent,promoting honest and accessible disclosure of information in a context of transparency enables patients to exercise their autonomy and, in doing so, to advance their own welfare as they understand it. At a very general level, contemporary models of the doctor patient relationship can thus be seen as reconciling four related but distinct values.

The first is fidelity to patient welfare. The commitment of physicians to promoting patient welfare and placing the interests of patients above competing interests is perhaps the oldest and most defining value of the medical profession. In fact, this was arguably the single, sovereign value of paternalistic models of the doctor-patient relationship.The rejection of medical paternalism ushered in a strong commitment to respect for patient autonomy.6 To respect the status of a person as autonomous is to enable that person to exercise their powers of deliberation and choice and then to honor the decision ultimately made.

The contemporary provider-patient relationship focuses on empowering patients to make decisions, in part because this is what is required to show respect for patients as moral agents. But promoting informed,autonomous choice is also likely to be the best strategy for promoting the value of fidelity to patient welfare.Because competent patients are considered to be the best judges of their own interests and values, they are taken to be the best stewards of their own welfare. On this view, the best way to uphold fidelity to patient welfare is to promote respect for patient autonomy.8 Once the relationship between health and welfare is understood, at least in part, as mediated or constructed by a persons broader goals, values, and life plans, then the clinician can no longer claim that her medical training provides special insight into how to advance patient welfare.

Discussion Forum 
Please take the time to reflect on and discuss the three assigned articles with your fellow group members and respond to one of the following questions. 
1. Do you agree or disagree with London and Kestigian’s argument that if, due to illness or incapacity, patients’ interests change then the link between respect for autonomy and fidelity to patent welfare is severed? Should we pay attention to the “then-self versus now-self” distinction in making our assessments or should we treat advance directives as a sort of Ulysses contract (i.e., a freely made decision that is intended to be binding in the future)?