Skip to Main Content
 

Global Search Box

 
 
 

ETD Abstract Container

Abstract Header

The Demands of Partnership: A Normative Foundation for Shared Medical Decision-Making

Massof, Allison Emily

Abstract Details

2018, Doctor of Philosophy, Ohio State University, Philosophy.
The contemporary vision of the doctor-patient relationship is a partnership. With the rejection of medical paternalism, ethicists and medical professionals recognized the importance of ensuring that patients were active participants in decisions regarding their care. In place of granting doctors authority to make medical decisions, doctors and patients are now expected to share authority over treatment decisions. However, this expectation is not supported by the current normative foundation for the doctor-patient partnership; specifically, its commitment to respect the patient’s right of self-determination. Therefore, the contemporary ideal of the doctor-patient relationship is at odds with the normative foundation upon which it rests. The aim of this dissertation is to offer a revision to the normative foundation for the doctor-patient partnership, in order to do justice to the ideal of a shared decision-making process. In Chapter 1, I detail the theoretical development of the ideal of the doctor-patient partnership and I identify a tension between the envisioned partnership and the commitment to respect the patient’s right of self-determination. In Chapter 2, I show that this tension is deeper than has been appreciated. The incompatibility between the doctor-patient partnership and the commitment to respect the patient’s right of self-determination runs deeper than has generally been acknowledged. In Chapter 3, I argue that we should abandon the commitment to respect the patient’s right of self-determination. I argue that the partnership model is worth preserving because it enables the doctor to function fully as a patient health advocate. The entitlement to try and persuade patients to revise decisions regarding their care is important for protecting patient health from being devalued. If we instead embrace an account of the doctor-patient relationship that requires that persuasion be justified, we lose out on a key dimension of this valuable social role. In Chapter 4, I offer a new account of the foundation for patient authority in medical decision-making. I argue that patients are entitled to participate in and control the outcome of medical decision-making due to an interest in not being dominated by the doctor. The patient’s interest in not being dominated not only provides a compelling account of the badness of medical paternalism; it also provides an account of why patients are entitled to directly participate in deliberation about their care and to be deferred to in cases of intractable faultless disagreement. However, non-domination is compatible with the doctor’s entitlement to try and persuade patients to revise their decisions. In Chapter 5, I conclude the dissertation by examining how to share decisional authority in such a way that the vision of the doctor-patient partnership can be achieved. I propose an alternative account of decisional authority that draws on Abraham Roth’s account of practical intersubjectivity. This account of decisional authority is distinctive because it awards doctors and patients the authority to reopen deliberation; this contrasts with the prior accounts’ focus on the authority to close deliberation. It is an account of this kind, I argue, that is able to secure the vision of the doctor-patient partnership.
Piers Turner (Advisor)
Dana Howard (Committee Member)
Tristram McPherson (Committee Member)
Abraham Roth (Committee Member)
231 p.

Recommended Citations

Citations

  • Massof, A. E. (2018). The Demands of Partnership: A Normative Foundation for Shared Medical Decision-Making [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1534724963173141

    APA Style (7th edition)

  • Massof, Allison. The Demands of Partnership: A Normative Foundation for Shared Medical Decision-Making. 2018. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1534724963173141.

    MLA Style (8th edition)

  • Massof, Allison. "The Demands of Partnership: A Normative Foundation for Shared Medical Decision-Making." Doctoral dissertation, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1534724963173141

    Chicago Manual of Style (17th edition)