PubMed · 7608940
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T Hope. 1995. Deception and lying.. https://doi.org/10.1136/jme.21.2.67
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The patient-physician relationship has undergone major and increasingly rapid changes in the past 40 years. It has moved from a relationship based on physician paternalism, through one of patient autonomy, to one where the patient and the physician's authority and control over the patient's care are facing significant threats from outside sources. In this article, we examine the historical and social forces that have contributed to these changes and the effects these forces have had on the traditional models of the patient-physician relationship. We present arguments to support our proposal for a patient-physician alliance in the community based on mutual education of physician and patient about health and illness, values and persons, social responsibility, beneficence, trust, and a degree of paternalism. We believe such an alliance offers the best hope for patients and their physicians to regain the initiative in guiding the evolution of health care in a way that preserves the essentials of the therapeutic relationship.
The prediction of susceptibility to heritable breast, ovarian and colon cancer raises important legal and ethical concerns. Health care professionals have a duty to disclose sufficient information to enable patients to make informed decisions. They must also safeguard the confidentiality of patient data. These duties may come into conflict if a positive finding in one patient implies that family members are also at risk. A legal distinction is made between a breach of confidentiality and the legitimate sharing of information in a patient's interest or to prevent harm to a third party. Physicians also have a fiduciary duty to warn. Other issues concern the legal liability assumed by genetic counsellors, whose disclosures may influence decisions about childbearing, for example, and the risk of socioeconomic discrimination faced by people with a known genetic susceptibility. Traditional ethical orientations and principals may be applied to these and other questions, but feminist ethics will likely have particular importance in the development of an ethical stance toward testing and counseling for heritable breast and ovarian cancer.
Because the science of genetics can have such profound effects on medicine and mankind, society must define the characteristics of a moral framework within which to make decisions about genetic issues. University of Manitoba medical student Deepak Kaura, who claimed third prize in CMAJ's 1995 Logie Medical Ethics Essay Contest, examines the ethics of genetic intervention in humans.