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What Patients Teach: The Everyday Ethics of Health Care

Oxford University Press
Place of Publication: 
New York

This book presents the core elements of a therapeutic relationship from the patient's perspective. It is based on extensive discussions with 58 patients with a wide range of illnesses. This book argues that illness, and the fragility of life it symbolizes, is a central feature of the human predicament, rather than an occasional interruption. This book presented a detailed description of the structure and rhythm of routine clinician-patient encounters. This book argues that the heart of healthcare ethics must be based on the structure and rhythm of routine encounters and that this model should displace the conventional and dominant big decisions model. In short, we reject the assumption that the core values of healthcare ethics have already been named and adequately analyzed in bioethical principles or the ethics codes of healthcare professionals. We must look to patients for a more adequate account. Being a patient is a unique interpersonal experience but it is also a universal human experience. The relationships formed when we are patients can also teach some of life's most important lessons, and these relationships provide a special window into ethics, especially the ethics of healthcare professionals. This book answers two basic questions: As patients see it, what things allow relationships with healthcare providers to become therapeutic? What can this teach us about healthcare ethics? This volume presents detailed descriptions and analyses of 50 interviews with 58 patients, representing a wide spectrum of illnesses and clinician specialties. The authors argue that the structure, rhythm, and horizon of routine patient care are ultimately grounded in patient vulnerability and clinician responsiveness. From the short interview segments, the longer vignettes and the full patient stories presented here emerge the neglected dimensions of healthcare and healthcare ethics. What becomes visible is an ethics of everyday interdependence, with mutual responsibilities that follow from this moral symbiosis. Both professional expressions of healthcare ethics and the field of bioethics need to be informed and reformed by this distinctive, more patient-centered, turn in how we understand both patient care as a whole and the ethics of care more specifically. The final chapters present revised codes of ethics for health professionals, as well as the implications for medical and health professions education. Introduction 1. Being a Patient and Living a Life 2. Clinical Space and Traits of Healing 3. False Starts and Frequent Failures 4. Three Journeys A. Ibuprofen and Love B. Staying Tuned Up C. We All Want the Same Things 5. Being a Patient: The Moral Field 6. Rethinking Healthcare Ethics: The Patient's Moral Authority Appendix Notes. (Publisher)