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Diminished capacity, friendship, and medical paternalism: Two case studies from fiction

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Abstract

We consider the moral and social ingredients in physicians' relationships with patients of diminished capacity by considering certain claims made about friendship and the physician's role. To assess these claims we look at the life context of two patients as elaborated examples provided in two novels: Woman on the Edge of Time (1976) by Marge Piercy, a radical feminist; and It's Hard to Leave While the Music's Playing (1977) by I. S. Cooper, a prominent physician-researcher. At issue is how the doctor-patient relationship should be structured. In question is whether the physician's friendship and professional expertise, together with the diminished capacity of the patient, authorize medical paternalism. From our examination, we find compelling insights against appealing to friendship both in good doctor-patient relationships and in more typical, not-so-good ones.

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References

  1. Ackerman, T. F., ‘Why doctors should intervene’, The Hastings Center Report 12, (1982) 14–17.

    Google Scholar 

  2. American Medical Association, ‘First Code of Medical Ethics’, in S. J. Reiser, A. J. Dyck, and W. J. Curran (eds.), Ethics in Medicine: Historical Perspectives in Contemporary Concerns, MIT Press, Cambridge, 1977, pp. 26–37.

    Google Scholar 

  3. Annas, G., ‘Hospital as a human rights wasteland’, The Civil Liberties Review 1, (1974) 15–35.

    Google Scholar 

  4. Anonymous, ‘Commentary’, Man and Medicine 3, (1978) 267–287.

    Google Scholar 

  5. Balint, M., The Doctor, Patient and His Illness, International Universities Press, New York, 1957.

    Google Scholar 

  6. Blum, L. A., Friendship, Altruism and Morality, Routledge and Kegan Paul, Boston, 1980.

    Google Scholar 

  7. Buchanan, A., ‘Medical paternalism’, Philosophy and Public Affairs 7, (1978) 370–390.

    Google Scholar 

  8. Cooper, I. S., It's Hard to Leave While the Music's Playing, W. W. Norton and Company, New York, 1977. (All quotations from the novel are reprinted by permission of the publisher.)

    Google Scholar 

  9. Culver, C. M., and Gert, B., Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry, Oxford University Press, New York, 1982.

    Google Scholar 

  10. Duffy, J., ‘The physician as a moral force in American history’, in W. B. Bondeson, H. T. Engelhardt, Jr., S. F. Spicker, and J. M. White, Jr. (eds.), New Knowledge in the Biomedical Sciences, D. Reidel, Dordrecht, 1982, pp. 3–21.

    Google Scholar 

  11. Erde, E. L., ‘On peeling, slicing and dicing an onion: The complexity of taxonomies of values and medicine’, Theoretical Medicine 4, (1983) 7–26.

    Google Scholar 

  12. Goldman, A., The Moral Foundations of Professional Ethics, Rowman and Littlefield, Totowa, New Jersey, 1980.

    Google Scholar 

  13. Gorovitz, S., ‘The physician as moral arbiter’, in W. B. Bondeson, H. T. Engelhardt, Jr., S. F. Spicker, and J. M. White, Jr. (eds.), New Knowledge in the Biomedical Sciences, D. Reidel, Dordrecht, 1982, pp. 23–31.

    Google Scholar 

  14. Ketchum, S. A., and Pierce, C., ‘Rights and responsibilities’, Journal of Medicine and Philosophy 6, (1981) 271–280.

    Google Scholar 

  15. Ladd, J., ‘Legalism and medical ethics’, Journal of Medicine and Philosophy 4, (1979) 70–71.

    Google Scholar 

  16. Lain-Entralgo, P., Doctor and Patient, World University Library, London, 1969.

    Google Scholar 

  17. Lief, H. I., and Fox, R. C., ‘Training for “detached concern” in medical students’, in H. I. Lief et al. (eds.), The Psychological Basis of Medical Practice, Harper and Row, New York, 1963, pp. 12–35.

    Google Scholar 

  18. MacIntyre, A., After Virtue, University of Notre Dame Press, Notre Dame, Indiana, 1981.

    Google Scholar 

  19. Meilaender, G., Friendship: A Study in Theological Ethics, University of Notre Dame Press, Notre Dame, Indiana, 1981.

    Google Scholar 

  20. Nabokov, V., ‘Nabokov on Dostoyevsky’, New York Times Magazine (August 23, 1981) 35–64.

  21. Parsons, T., The Social System, The Free Press, Glencoe, Illinois, 1951.

    Google Scholar 

  22. Pellegrino, E. D., and Thomasma, D. C., A Philosophical Basis of Medical Practice, Oxford University Press, New York, 1981.

    Google Scholar 

  23. Piercy, M., Woman on the Edge of Time, Alfred A. Knopf, New York, 1976. (All quotations from the novel are reprinted by permission of the publisher.)

  24. Putnam, H., Meaning and the Moral Sciences, Routledge and Kegan Paul, Boston, 1978.

    Google Scholar 

  25. Rabin, D., with Rabin, P. L., and Rabin, R., ‘Compounding the ordeal of ALS: Isolation from my fellow physicians’, The New England Journal of Medicine 307, (1982) 506–509.

    Google Scholar 

  26. Reiman, J. H., ‘Privacy, intimacy, and personhood’, Philosophy and Public Affairs 6, (1976) 26–44.

    Google Scholar 

  27. Sonn, M., ‘Patient's subjective experiences of psychiatric hospitalization’, in T. C. Manschreck and A. M. Kleinman (eds.), Renewal in Psychiatry, Hemisphere Publishing Company, Washington, DC, 1977, pp. 245–264.

    Google Scholar 

  28. Sterba, J. H., ‘Nobel winner urges wider forensic use of new insulin technology’, New York Times (March 23, 1982) C2.

  29. Toulmin, S., ‘The tyranny of principles’, The Hastings Center Report 11, (1981) 31–39.

    Google Scholar 

  30. Veatch, R. M., ‘Generalization of expertise’, The Hastings Center Studies 1, (1973) 29–40.

    Google Scholar 

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Although it cannot be assumed that he is in accord with our argument in this essay, we would like to thank David Thomasma for his criticism of an earlier draft.

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Erde, E.L., Jones, A.H. Diminished capacity, friendship, and medical paternalism: Two case studies from fiction. Theor Med Bioeth 4, 303–322 (1983). https://doi.org/10.1007/BF00489211

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