Tag Archives: Medicine

The Nature of Communication between Physician and Patient in Western Medicine

One feature of Western medicine’s social institution that serves to maintain authority/power in the hands of the physician is insulating the layperson from properly understanding what may be ailing him/her. Illich defines this process as “medical mystification” (80). It is an intellectual obscuring of sorts and stems from the physician’s special knowledge and training as it pertains to the proper functioning of the human body.

The other part of this insulation between the patient and the physician lies in the style of communication between the two. In referring to this style, or mode, of communication one must not only look at the vocabulary utilized by the physician but also at the structure of conversation between the patient and physician such as when the former enters into a hospital for medical purposes.

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Power and Authority in the Patient/Physician Relationship in Western Medicine

The largest disparity between position in the social hierarchy of Western medicine is between the patient and the physician. The patient/physician interaction is critically shaped by the rigidity of the social hierarchy. In describing the nature of the patient/physician relationship, Parsons lays out four distinct features that establish and maintain a particular form of the subordinate/superior relationship, most commonly expressed in terms of power/authority.

Before going further, an extremely important distinction must be drawn. Power and authority are, categorically, not the same things. For instance, in at least one form, the legitimization of authority allows one to exercise more power. Authority therefore enhances elements like one’s reputation or one’s social standing. Authority, also, could be viewed as an entirely different form of power. Whereas power may stipulate the explicit use of force/coercion (i.e. violence), authority may stipulate a softer version of that with similar end results but without the use of force/coercion. Instead, psychological mechanisms and tools may be utilized. I don’t want to go too far down the rabbit hole on this, but suffice it to say they are conceptually and logically distinct and should be kept that way for current purposes.

In this case, the physician is bestowed with authority through his/her extensive knowledge of the human body, coupled with the recognition of the former by the social structure known as medical school. The authority of the physician allows him/her to suggest, recommend, and, in some cases, command the patient to complete or permit certain actions.

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Moral Reasoning in the Context of Physician Assisted Suicide (PAS)

A Statement of Values — Proponents versus Opponents

Collectively, the proponents of physician assisted suicide value personal autonomy and responsibility, the quality of life, and compassion towards others. Proponents of physician assisted suicide feel that by being allowed to choose between life and death as a personal and medical decision, patients are able to exercise personal autonomy, a freedom that they take to be fundamental to the nature of humanity. This autonomy ties directly into their perceptions about quality of life, in that some view life as undesirable or lackluster if they are not able to enjoy activities, events, and relationships that they previously did due to terminal or incurable medical conditions. They do not view life as inherently valuable and worth living, but derive life’s value from its pragmatic and functional elements. When the level and intensity of physical and mental suffering crosses a certain threshold, these proponents value the actions of those who will show compassion and act in accordance with their final wishes. Thus, proponents of physician assisted suicide feel obligated to protect the personal rights of patients as well as to ensure that they are being treated with compassion to alleviate their pain and suffering. Any events or legislation that interfere with those conditions are intolerable.

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Suggestions for Medical Testing on Human Subjects

Analysis:

Ultimately, I agree with Miller et al. that the moral principles which govern clinical medical practice should not be confused with the moral principles which should govern clinical medical research. While the Principles of Non-Maleficence [1], Clinical Equipoise [2], and Beneficence [3] ought to be strictly observed within the context of clinical practice, the differences in purposes, methodology, and costs of clinical practice compared to clinical research make it clear that they are not the same and should not be treated as such. But I am also sympathetic, at least in part, to Freedman et al. in that there is still room for significant improvement. As a result, I seek to argue for a kind of middle ground in this particular debate.

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