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The Person in a State of Sickness

The Doctor-Patient Relationship Reconsidered

Published online by Cambridge University Press:  09 March 2016

VILHJÁLMUR ÁRNASON  and
STEFÁN HJÖRLEIFSSON
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Abstract:

In this article, we discuss the ideas of Eric J. Cassell about the patient-professional relationship. We argue that his approach combines in an interesting way features from the literature on patient autonomy and paternalistic practices. We suggest that these seemingly paternalistic features of practicing medicine, which are widely either ignored or condemned in bioethical discussion, are of vital significance in medical practice. In the first sections of the article, we describe the main features of Cassell’s understanding of the sick person and his version of personalized medicine. We pay particular attention to his notion of information control and compare his ideas about conversation with patients to Hans-Georg Gadamer’s analysis of patient-professional dialogue. In the latter part of the article, we explore through a couple of examples the implications these ideas have for medical practice.

Keywords

Eric J. Cassellpatient-professional relationshippatient autonomypaternalism in medicineHans-Georg Gadamer
Type
Special Section: Responsibility, Vulnerability, Dignity, and Humanity
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Issue 2 , April 2016 , pp. 209 - 218
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

1. Cassell, EJ. The Nature of Healing: The Modern Practice of Medicine. Oxford: Oxford University Press; 2012.CrossRefGoogle Scholar

2. See note 1, Cassell 2012, at 50.

3. See note 1, Cassell 2012, at 64.

4. See note 1, Cassell 2012, at 62.

5. See note 1, Cassell 2012, at 4n.

6. Hamburg, MA, Collins, FS. The path to personalized medicine. New England Journal of Medicine 2010;363:301–4.CrossRefGoogle ScholarPubMed

7. See note 1, Cassell 2012, at 59.

8. See note 1, Cassell 2012, at xiv.

9. See note 1, Cassell 2012, at 63.

10. See note 1, Cassell 2012, at 143.

11. See note 1, Cassell 2012, at 255.

12. See note 1, Cassell 2012, at 236.

13. See note 1, Cassell 2012, at 240.

14. See note 1, Cassell 2012, at 236.

15. See note 1, Cassell 2012, at 189.

16. Cf. Smith, S. Three models of the nurse-patient relationship. In: Mappes, TA, Zembaty, JS, eds. Biomedical Ethics. New York: McGraw-Hill; 1981:120–6.Google ScholarVeatch, RM. Models for ethical medicine in a revolutionary age. In: Mappes, TA, Zembaty, JS, eds. Biomedical Ethics. New York: McGraw-Hill; 1981:56–9.Google Scholar

17. See note 1, Cassell 2012, at 189.

18. This can be seen in various guidelines for communicating bad news to patients.

19. See note 1, Cassell 2012, at 92.

20. See note 1, Cassell 2012, at 92.

21. See note 1, Cassell 2012, at 91.

22. See note 1, Cassell 2012, at 239.

23. See note 1, Cassell 2012, at 181.

24. See note 1, Cassell 2012, at 181.

25. See note 1, Cassell 2012, at 182.

26. Gadamer, H-G. Truth and Method. New York: The Seabury Press; 1975:321–3.Google Scholar

27. Cf. Árnason, V. Gadamerian dialogue in the patient-professional interaction. Medicine, Health Care and Philosophy 2000;3:17–23.CrossRefGoogle Scholar

28. See note 26, Gadamer 1975, at 330.

29. See note 1, Cassell 2012, at 181.

30. See note 1, Cassell 2012, at 181.

31. See note 1, Cassell 2012, at 238.

32. See note 1, Cassell 2012, at 239.

33. See note 1, Cassell 2012, at 239.

34. See note 1, Cassell 2012, at 239.

35. Cf. Ezekiel, JE, Ezekiel, LL. Four models of the physician-patient relationship. JAMA 1992;267(16):2221–6.Google Scholar

36. See note 1, Cassell 2012, at 102.

37. See note 1, Cassell 2012, at 102.

38. See note 1, Cassell 2012, at 102.

39. See note 1, Cassell 2012, at 102.

40. E.g., Kristinsson, S. Autonomy and informed consent: A mistaken association? Medicine, Health Care and Philosophy 2007;10(3):253–64.CrossRefGoogle Scholar

41. See note 1, Cassell 2012, at 255.

42. Stewart, M, Brown, JB, Weston, WW, McWhinney, IR, McWilliam, CL, Freeman, TR. Patient-Centered Medicine: Transforming the Clinical Method. London: Radcliffe; 2014.Google Scholar

43. See note 1, Cassell 2012, at 239.

44. See note 1, Cassell 2012, at 239.

45. Schei, E. Doctoring as leadership. Perspectives in Biology and Medicine 2006;49(3):393–406, at 393.CrossRefGoogle Scholar

46. See note 1, Cassell 2012, at 181.

47. See note 1, Cassell 2012, at xiv.