’Confusing the purpose of the medical relationship in Law: a return to beneficence-in-trust as the basis of Medicine.

Conference: Institute of Medical Ethics Online Seminar

Dates: 10 November 2021

Journal: https://ime-uk.org/events-and-news/news/online-seminar-josh-parker-matthew-watkins-video-recording/

Place of Publication: https://ime-uk.org/events-and-news/news/online-seminar-josh-parker-matthew-watkins-video-recording/

Abstract:

It is nearly 20 years since O’Neil published Autonomy and Trust in Bioethics. This seminal book exposed the relationship between the reduction in public trust and the dramatic increase in both ethical and legal regulation of medical decision-making. However, rather than fill the void with a coherent set of beneficent principles, certain members of the judiciary have embarked on a campaign to shift the power in the medical relationship to the patient. Adopting the mantra: the patient rather than the doctor must decide. This paper will argue that the development of Negligence case-law has led to the piecemeal eradication of medical discretion. Worse, the Law has re-characterised doctor-patient relationship: from one grounded on moral principles, to one based on servicing the patient consumer. Not only is this alien to the British conception of medicine, it is damaging to both the patient and the doctor. First, it legitimises abandoning the inexpert, and vulnerable, patient to complex and potentially harmful decision-making. Second, it divorces the doctor from the moral basis, principles and virtues, which require them to care for the patient in the act of medicine. Without this moral basis to guide her actions, a doctor can only act by following rules to avoid sanction. If these rules are decided by the patient, there is every possibility that the doctor will forced to do harm. When harm occurs the cycle of regulation continues.

Adopting the scholarship of Thomasma and Pellegrino, this paper advocates that only when the patient, and society at large, can trust that all doctors are acting upon shared moral principles will this cycle end. The the first step is a collective conception of the purpose of medicine: as Beneficence-in-trust.

Source: Manual