Obectives. At the end of this lesson you should: After you have decided on the extent of your moral community, the next question to consider is what ought to be the relationship between a health care professional and the one being served.

Relationship establishes the locus of decsion making and the parameters of interacticon

Collegial relationships are between those who are colleagues. Those who argue that health care realationships should be collegial say that the professional has special knowledge and experince in medicine, nursing etc. AND the client has special knowlege of his/her body, life context, history, value etc. If both parties work together sharing their knoweldge they will arrive at good health care decisions

Fiduciary relationships occur when one party has special knoweldge that they put at the disposal of another, their client. The client listens to the advice and reasoning of the specialist and the client makes his or her own decisions. The professional advises, shares knoweldge but is not part of the decision making.

Paternalism - derived from pater - father holds that the health care professional has the essential knoweldge and expereince and so s/he should be the one making medical decisions. Patients need to follow treatment.

Scientific/engineering relationship is one in which the medical person is there to perform certain tasks. The right relationship is one that is emotionally detached and scientificly, technically excellent.

Here are some phrases often used in health care situations. What relationship is refelcted in each?

  1. "Bill Smith is another non-compliant diabetic!"
  2. "Those are the options for treatment. Do you have any questions? No? Then which one do you want to follow?"
  3. "Here is a scrip for an MRI. You can make a follow up appointment for about a week after you have the MRI. Be sure to call Ms. Jones to make sure I have the report before you come in. I really hope that you will be feeling better soon"
  4. "I have a torn rotator cuff, followed by a bone spur this morning."
  5. "I am thinking that we could do either a root canal and cap on this tooth or we could extract it. What do you think? Can you afford a root canal? Would it be bothersome to you to be missing a molar?"
  6. "We are having some problems with the apendectomy in Room 212....."
  7. "Given what you have said, I would suggest that you consult a urlogist as soon as possible."

Now, think of TV, movies or books and see if you can idenitify at least one practitioner for each relationship.

Now, think of the dentists, doctors, nurses and lab technicians you have known and try to name their self-client relationships.

Finally and this is the most important issue: What do you think is the "right relationship" between health care professional and client? NOTE: If you say, there is no one right relationship, then you need to specify the criteria we should use to decide which of the many relationships is right for this client or that one. If you have no reason, then the relationship choice should be left to a roll of the dice or some other game of chance. Is that what you think? If not, what will you use to determine the right relationship with each patient/client?

A wider context for considering this issue of right relationship is to return to your moral community. What should be the right relationship with each being in your statement of your moral community?
See if you can write out your philosophy of right relationship by stating what the right relationship should be and why that is the correct relationship.

I suggest that you put this in writing so that you will have your exact wording in front of you when we discuss this item in class.