Patient-Physician Relation

"Veatch, an eminent medical ethicist, addressed the concept of a contractual physician—patient relationship applied to research settings in The Patient as Partner: A Theory of Human—Experimentation Ethics (CH, Sep'87). In this new volume he applies it to routine clinical encounters. Cogent arguments are presented to show the inappropriateness of traditional authoritarian interactions for modern clinical encounters. Chapters examine patients' values, the concept of medical indications (which Veatch argues contains embedded values and biases), and application of the proposed model to malpractice, generic prescribing, use of investigational drugs, drug use for nonapproved purposes, placebos, access to medical records, and notions of confidentiality and duty. Part 3 of the book includes four chapters dealing with the principle of justice, too often neglected in American writings about medical ethics. The work concludes with chapters dealing with special problems: transplantation, guardianship, do—not—resuscitate orders, and ethics committees. The final chapter summarizes and discusses these concepts in the context of medicine's changing technology and culture. This outstanding discussion of important current medical issues is a valuable addition to academic and professional libraries."—L. A. Crandall, University of Florida , Choice, September 1991

• PrefaceAcknowledgmentsIntroductionPart I. The Foundations of the Patient-Physician Relation1. Models for Ethical Medicine in a Revolutionary Age2. Medical Ethics: Professional or Universal?3. The Physician as Stranger: The Ethics of the Anonymous Patient-Physician Relationship4. Values in Routine Medical Decisions5. The Concept of "Medical Indications"6. The Principles for Medical EthicsPart II. The Individual Professional-Patient Relation7. Informed Consent: The Emergeing Norms8. Malpractice in the Contract Mode9. The Ethics of Generic Drug Use10. Treatment INDs: The Right of Access to Experimental Drugs11. Ethics of Drugs for Nonapproved Uses12. When Should the Patient Know? The Death of the Therapeutic Privilege13. An Unexpected Chronosome: Disclosure of Genetic Information14. The Ethics of Dispensing Placebos15. The Patient's Right of Access to Medical Records16. The Limits of Confidentiality: The Case of the Homosexual Husband17. Patients' Duties and Physicians' RightsPart III. The Social Professional-Patient Relation18. Autonomy's Temporary Triumph: On the Alleged Conflict between Autonomy and Justice19. DRGs and the Ethics of Cost Containment20. Justice and Economics: Care of the Terminally Ill, Persistently Vegetative, and Elderly21. Voluntary Risks to Health: The Ethical IssuesPart IV. Special Problem Areas22. The Ethics of Organ Transplantation23. The Technical Criteria Fallacy: The Case of Spina Bifida24. Limits of Guardian Treament Refusal: A Reasonableness Standard25. "Do Not Resuscitate" Orders: An Ethical Analysis26. The Ethics of Institutional Ethics CommitteesPart V. The Future of the Partnership27. Contemporary Bioethics and the Demise of Modern MedicineNotesIndex