Avoiding Paternalism With Plato: Levin’s Doctor Patient Tie

1582 words - 7 pages

The truly collaborative relationship model between doctor and patient has so far been elusive. In Susan Levin’s paper, The Doctor-Patient Tie in Plato’s Laws: A Backdrop for Reflection, the author critiques two models proposed by Ezekiel and Linda Emanuel, and Edmund D. Pellegrino and David C. Thomasma. On review, both come close to striking the perfect balance, but ultimately fail. Their failures lie in the possibility for their models to become paternalistic which is thought of as a flawed model. In the paper, Levin proposes an approach of her own which adopt concepts from Plato’s Laws. In this essay I will argue that with the help of Plato’s ideas, Levin is able to create a model which ...view middle of the document...

Pellegrino and Thomasma and the Emanuel’s both include emphasis on patient autonomy into their own proposed ideal models, but aim for a collaborative model which refrains from being too close to either extreme.
The Emanuels endorse a possible solution known as the deliberative model in their paper “Four Models of the Physician-Patient Relationship”. This model is meant to disassociate from the informative model and to make strides toward an ideal doctor-patient collaboration. The deliberative model can be described as an ‘informed ought’ because the doctor and patient have deliberated: the doctor’s obligation is in “articulating and persuading the patient of the most admirable values”(2222). A doctor is regarded as a friend or teacher who comes to know what is best for the patient after communicating concerns to one another. While opening up dialogue between the doctor and patient moves the model away from the informative model, the deliberative model fails because it still involves the assumption that the doctor will be able to discern the best solution and then advise the patient which aligns the model with that of the paternalistic. A problem with this assumption is that a doctor can believe that they have collaborated with the patient effectively and so believes they are able to discern the best treatment for the individual when in reality they may unwittingly be advising a course of action which aligns with their own morals. Another failure rests in the assumption that doctors have gone through ethics training and have the ability to give moral advice in the first place. In reality a doctor may not have necessarily received this sort of education and so would not be able to collaborate with the patient on the topic of the most admirable values.
The alternative relationship posed by Edmund Pellegrino and David Thomasma fail for much of the same reasons as the Emanuels’ deliberative doctor-patient model. In their model “the doctor’s overarching vision enable her to discern whether a patient's response to his situation is worthy of her endorsement” and judgement of the doctor ultimately “determines whether the patient is acting in a fashion worthy of respect” or if the patient’s “preference should be overridden” (356). Again the model fails because it assumes that the doctor has superior moral knowledge and from that assumption emerges an unwarranted power over the patient. In this case the doctor is ‘worthy’ of power over the patient because they are expected to have knowledge of, and to identify the course of action which, is morally best. The problem is that one does not know the educational background of a doctor beyond that of medical training. Also, even if the doctor has been educated about morals, there is no reason to believe that the doctor would then be able to act as a competent judge of morals for the patient because the doctor could believe they know the best solution for the patient when in reality the solution is more inline...

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