What Patients Teach: The Everyday Ethics of Health Care

by Larry R. Churchill, Joseph B. Fanning, David Schenck

Overview

Being a patient is a unique interpersonal experience but it is also a universal human experience. The relationships formed when we are patients can also teach some of life's most important lessons, and these relationships provide a special window into ethics, especially the ethics of healthcare professionals. This book answers two basic questions: As patients see it, what things allow relationships with healthcare providers to become therapeutic? What can this teach us about healthcare ethics? This volume presents detailed descriptions and analyses of 50 interviews with 58 patients, representing a wide spectrum of illnesses and clinician specialties. The authors argue that the structure, rhythm, and horizon of routine patient care are ultimately grounded in patient vulnerability and clinician responsiveness. From the short interview segments, the longer vignettes and the full patient stories presented here emerge the neglected dimensions of healthcare and healthcare ethics. What becomes visible is an ethics of everyday interdependence, with mutual responsibilities that follow from this moral symbiosis. Both professional expressions of healthcare ethics and the field of bioethics need to be informed and reformed by this distinctive, more patient-centered, turn in how we understand both patient care as a whole and the ethics of care more specifically. The final chapters present revised codes of ethics for health professionals, as well as the implications for medical and health professions education.

Product Details

ISBN-13:	9780190650582
Publisher:	Oxford University Press
Publication date:	11/01/2016
Edition description:	Reprint
Pages:	208
Product dimensions:	5.40(w) x 8.10(h) x 0.60(d)

About the Author

Larry R. Churchill is the Anne Geddes Stahlman Professor of Medical Ethics, Professor of Medicine and Professor of Philosophy and Religion at Vanderbilt. His major works include a 1987 book Rationing Health Care in America (Univ. of Notre Dame Press), a 1994 book Self-Interest and Universal Health Care (Harvard Univ. Press, selected a Choice Magazine Outstanding Academic Book for 1995). With Marion Danis and Carolyn Clancy he edited Ethical Dimensions of Health Policy, (Oxford University Press) in 2002. His most recent book, with David Schenck, is Healers: Extraordinary Clinicians at Work (Oxford Univ. Press, 2011). Churchill's work in ethics and health policy was the basis for his election to the Institute of Medicine, National Academy of Sciences, in 1991, and his selection as a Fellow of the Hastings Center in 2000.

Joseph B. Fanning is Assistant Professor of Medicine in the Center for Biomedical Ethics and Vanderbilt University Medical Center. He serves as the Director of the Clinical Ethics Consultations Service and works with patients, families and clinicians on ethical concerns that arise in patient care. His research focuses on the importance of communication in building therapeutic relationships. In 2009, Fanning co-edited with Ellen Wright Clayton a special issue of the American Journal of Medical Genetics that focused on spiritual and religious issues in medical genetics. He has also co-authored articles on the philosophy and practice of clinical ethics consultation. He is a lead investigator on a pilot project funded by the Baptist Healing Trust that seeks to understand how health care teams and families of incapacitated patients coordinate expectations about the future course of care. Fanning also teaches healthcare ethics across the medical center and directs an undergraduate course on death and dying in America.


David Schenck is a Research Assistant Professor, Department of Medicine, of the Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center. After twenty years as a professor of philosophy and religion, Schenck served as the founding executive director of a free medical clinic, and as a counselor and healthcare advocate for the homeless. He has volunteered and worked for many hospices over the last twenty years. Schenck has published articles in: Annals of Internal Medicine, Cambridge Quarterly of Healthcare Ethics, Social Medicine Reader, Society, Journal British Society Phenomenology, Phenomenology and Philosophical Research, Soundings, Journal of Religious Ethics, International Philosophical Quarterly, International Studies in Philosophy, Human Studies. He is the author, with Larry R. Churchill, of Healers: Extraordinary Clinicians at Work (Oxford University Press, 2011)

Table of Contents

Introduction
1. Being a Patient and Living a Life
2. Clinical Space and Traits of Healing
3. False Starts and Frequent Failures
4. Three Journeys
A. "Ibuprofen and Love"
B. "Staying Tuned Up"
C. "We All Want the Same Things"
5. Being a Patient: The Moral Field
6. Rethinking Healthcare Ethics: The Patient's Moral Authority
Appendix
Notes

Editorial Reviews

"This an outstanding contribution to the ethics literature—thoughtful, analytic, original, and exceptionally attuned to the dynamic, 'doubled-agency' aspects of the doctor-patient relationship. Combining profound insight with empirical data gleaned from in-depth interviews, the authors challenge the received wisdom that the abstract framework of principled-centered ethics will suffice to solve clinical problems. All those involved in conducting and teaching ethics consultations will benefit from this book." — Larry Schneiderman, Professor Emeritus, Medicine and Family & Preventive Medicine, University of California, San Diego

"The near-universal complaint among disappointed patients is, 'My doctor doesn't listen.' Churchill, Schenck, and Fanning let the patients themselves tell us exactly what it means to listen within the context of a truly therapeutic relationship, thoughtfully describing the unglamorous, everyday world of solid medical practice. Along the way, they force us to rethink many of our assumptions about what most matters ethically in health care." — Howard Brody, John P. McGovern Centennial Chair in Family Medicine and Director, Institute for the Medical Humanities, University of Texas Medical Branch

"What Patients Teach, with its companion volume, Healers, gives health-care professionals the clearest, most practical, best researched guide to relationships with their patients. Few books offer as constructive a vision of what clinical care can be. The authors' concluding call for a reorientation of bioethics to focus on patients' vulnerability deserves to debated and, I hope, implemented. These books are essential reading for anyone concerned with the humane delivery of health care." — Arthur W. Frank, author of The Wounded Storyteller (new edition, 2013) and Letting Stories Breathe

"This is an essential book in medical ethics. Drawing on extensive interviews, the authors emphasize the patient's agency and the body's belonging to a community, and they see the trust that's central to the patient-physician relationship as a reciprocity of vulnerability and responsiveness. This "doubled agency" leads them to a reassessment of principlism; in their view ethical principles are the boundary conditions of that relationship, useful primarily when trust fails." — Kathryn Montgomery, Professor of Medical Humanities & Bioethics and Medicine, Northwestern University

"This is a good resource to highlight the patient perspective for clinicians. The authors allow patient stories to be told with little interruption, preserving an authentic patient voice, and still carry out an effective discussion and analysis of the contributions that these perspectives make to the ethics of healthcare." —Kathryn E. Raliski, MA, Doody's Health Sciences Book Review

From the Publisher

Reviewer: Kathryn E. Raliski, MA (Saint Louis University)
Description: This book describes and analyzes 55 interviews with 58 patients who represent a broad spectrum of illnesses and clinician specialties.
Purpose: The purpose is to respond to questions such as: From a patient's perspective, what are the core elements that allow relationships with healthcare providers to become therapeutic? And, what are the lessons for healthcare ethics? This two-part task is important because patient perspectives on therapeutic relationships can illuminate a more suitable account of the core values of healthcare ethics. The authors successfully demonstrate how knowledge of the dynamic between patient vulnerability and clinician responsiveness contributes to the understanding of ethically complex relationships in clinical settings.
Audience: The book is intended for anyone who routinely interacts with patients in a professional helping capacity. This includes nurses, physicians, chaplains, clinical social workers, bioethicists, health coaches, and counselors. Medical students, medical educators, and patient support organizations also may find this book of interest. As faculty members at a large academic medical center, whose activities are often focused on ethics in the clinical context, the authors have relevant experience in healthcare ethics.
Features: Ten vignettes introduce the major themes of the book, and are followed by discussion of relational skills and failures. Through vignettes and shorter interview segments, frequently overlooked dimensions of healthcare emerge. An analysis of patient perspectives indicates the need for a set of core concepts for understanding and judging the ethics of a more patient-centered healthcare. The final chapters propose revised codes of ethics for professionals. A revised medical oath may include the following pledge: "I will always seek to identify the person behind and beyond the patient before me and his/her presenting symptoms."
Assessment: This is a good resource to highlight the patient perspective for clinicians. The authors allow patient stories to be told with little interruption, preserving an authentic patient voice, and still carry out an effective discussion and analysis of the contributions that these perspectives make to the ethics of healthcare.

Doody's Review Service