ABSTRACT
Healthcare, ultimately, is about treating the patient. So let’s start by examining how the relationship between the caregiver and patient sets the stage for ethical considerations that transcend that relationship and permeate the culture of management. Today’s notion of the patient as consumer, in which the patient’s consent to treatment, as well as to access to information and entitlement to respectful treatment, is a culmination of an evolutionary process that can be traced to the Hippocratic period of almost 2,500 years ago. It was during this period that the concept of beneficence was established and became fundamental to caregiving practices. Emerging from the concept of “doing no harm,” the beneficence model placed the physician and the physician’s decision-making at the center of caregiving. The Hippocratic Oath reflects the primacy of the physician’s role; it established responsibilities for the physicians but includes no discussion of the patient with respect to a role in decision-making (Miles, 2003). A premise of the oath was that the physician belonged to a highly specialized group which, by virtue of the members’ superior knowledge and training, were bestowed with significant, if virtually exclusive, rights as arbiters of health. This special status was to be used in the service of caring for patients who were relegated to adopting a passive decision-making role. The all-knowing physician would exercise discretion in what was communicated to the patient; withholding or even falsifying information about the patient’s condition could be seen as essential to ensuring the patient’s compliance – that is, such lying or concealing was done if it was seen to be in the patient’s best interest.
