Part II - Moral foundations of the therapeutic relationship

Summary

Therapeutic relationships between patients and professionals are at the center of health care; they are the primary mechanism for realizing its cherished goals of health, healing, and comfort. Part II of this volume examines six moral foundations of these therapeutic relationships:

1. • respect for patient privacy and confidentiality

2. • truthful communication

3. • informed consent to treatment

4. • surrogate decision-making for patients who lack decision-making capacity

5. • respect for professional boundaries

6. • responsible stewardship of health care resources

These six foundations are widely recognized as essential for the provision of effective, equitable, and respectful health care.

Chapter 6, “Privacy and confidentiality,” first examines the meaning of these concepts and their application in health care settings. Then it argues that respect for privacy and confidentiality preserves patient autonomy, promotes beneficial treatment outcomes, and protects patients from harm. The chapter acknowledges that respect for privacy and confidentiality may be limited by other duties, including duties to obey the law and to protect both patients and third parties from harm.

Chapter 7, “Truthfulness,” explores professional duties to communicate truthfully with patients. It bases these duties on respect for patients’ rights to know about their condition and its treatment, the ability of patients to accept even bad news, and the benefits to patients of making decisions based on a clear understanding of their condition, prognosis, and treatment alternatives.

Chapter 7 describes and endorses an account of what it means to be truthful that was proposed by physician Richard Cabot. It distinguishes duties to provide truthful information from duties to protect the confidentiality of that information, and it recognizes that patients may choose to waive their right to receive personal health information.

Chapter 8 is devoted to examination of patient rights to give or withhold, and professional duties to obtain, informed consent to medical treatment. After a brief summary of the legal origins and moral foundations of informed consent, the chapter describes the three essential elements of informed consent, namely, the patient must have the capacity to consent, the health care professional must provide relevant information about the treatment decision, and the patient must be free to choose.