Briefly explain the 4 models of doctor-patient interaction discussed in the Emmanuel & Emmanuel paper. Which model do the authors defend as an ideal framework for healthcare practice? What are their reasons for thinking this, according to the paper? Do you think that their preferred model violates patient autonomy, why or why not?
Consider “Case 2”, at the end of Chapter 4 (Vaughn, 179): What options might the researcher have? what bioethical principles are in conflict, in this case? What do you think the researcher should do? Suppose there’s a law dictating that patients’ HIV status should never be disclosed: does that change your answer? Why or why not?
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The 4 models of doctor-patient interaction
Full Answer Section
The authors of the paper argue that the deliberative model is the ideal framework for healthcare practice. They give several reasons for this:
- The deliberative model is the most respectful of patient autonomy.
- The deliberative model is the most likely to lead to a decision that is in the patient's best interest.
- The deliberative model is the most consistent with the principles of medical ethics.
I do not believe that the deliberative model violates patient autonomy. In fact, I believe that it is the only model that fully respects patient autonomy. The other models all involve the doctor making decisions on the patient's behalf, to some extent. The deliberative model, on the other hand, involves the doctor and patient working together to make a decision that is consistent with the patient's values.
In Case 2, the researcher has a number of options. She could:
- Disclose the patient's HIV status to the other researchers without the patient's consent.
- Disclose the patient's HIV status to the other researchers with the patient's consent.
- Not disclose the patient's HIV status to the other researchers.
The bioethical principles in conflict in this case are the principle of beneficence (the duty to do good) and the principle of autonomy (the right to make one's own decisions). The principle of beneficence requires the researcher to disclose the patient's HIV status to the other researchers in order to protect them from infection. However, the principle of autonomy requires the researcher to respect the patient's right to make their own decision about whether or not to disclose their HIV status.
I believe that the researcher should not disclose the patient's HIV status to the other researchers without the patient's consent. I believe that the principle of autonomy should outweigh the principle of beneficence in this case. The patient has the right to make their own decision about whether or not to disclose their HIV status, and the researcher should respect that right.
If there is a law dictating that patients' HIV status should never be disclosed, then the researcher would be legally obligated to not disclose the patient's HIV status to the other researchers. However, I believe that the researcher would still have a moral obligation to respect the patient's autonomy and to inform the patient of their options.
Ultimately, the decision of whether or not to disclose the patient's HIV status to the other researchers is a difficult one. There are strong arguments on both sides. However, I believe that the principle of autonomy should weigh most heavily in this case. The patient has the right to make their own decision about whether or not to disclose their HIV status, and the researcher should respect that right.
Sample Answer
Here is a brief explanation of the four models of doctor-patient interaction discussed in the Emmanuel & Emmanuel paper:
- Paternalistic model: The doctor makes decisions for the patient based on what the doctor believes is in the patient's best interest.
- Informational model: The doctor provides the patient with all of the relevant information and then allows the patient to make their own decision.
- Interpretive model: The doctor helps the patient to understand their values and to make a decision that is consistent with those values.
- Deliberative model: The doctor and patient work together to make a decision based on the patient's values and the best available medical evidence.
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