A Catholic Prescription for a Healthy Doctor-Patient Relationship
COMMENTARY: When we see both the patient and the doctor as equally worthy of dignity and respect, while understanding that the role of the doctor is to serve the patient, we then have a solid foundation from which to build an ethical, life-affirming and economically sustainable health care system.
Now is the perfect time, as we pull away from the pandemic, to restore balance in the doctor-patient relationship — to place the dignity of the human person at the center of the relationship and build an ethical, life-affirming and sustainable healthcare system.
All of this is particularly urgent in light of the fact that mainstream medicine and the Ethical and Religious Directives (ERD), which are binding on Catholic healthcare facilities, diverge in a number of areas. The pressure on Catholic healthcare facilities to act contrary to these ERDs is immense. To avoid scandal to the Body of Christ, unnecessary conflict with the broader healthcare culture, and to ensure that the focus is on the corporal and spiritual works of mercy, Catholic healthcare institutions should take pains to educate their employees about the true nature of medicine. Grace builds upon nature, so we cannot expect Catholic health care that witnesses to the resurrection of the body and eternal life in imitation of Christ unless we are clear about the nature of health care itself. Now is the time to reaffirm the foundation of medicine as service to the human person made in the image of God and called to the likeness of God (Genesis 1:26).
To understand the nature of the doctor-patient relationship, we need to begin by understanding the nature of the human person as an integration of soul, mind, and body, capable of reason, inherently relational, and called to communion on the level of knowledge and love. With this in mind, doctors must be attentive that the patients they are treating are persons of intrinsic dignity whose vocation is love. Likewise, patients must be aware that their doctors have equal dignity and a special competence in medicine. The doctor is to serve the patient by seeking to the best of his or her ability to restore the patient’s health. In the most basic sense, the medical profession is about helping the patient — as a human person — recover his or her full health.
Medicine is a service industry. The doctor is the one who serves, and the patient is the one being served. Yet, there are three primary distortions of the doctor-patient relationship that have developed over time which impede this relationship and, thereby, true health care.
A prevalent distortion is to subordinate the doctor-patient relationship to larger corporate and government entities that have other priorities than the health of patients. When hospital systems decide whether to provide care based on the financial gain coming into their facilities, when governments decide which treatments are included in government funded health care based purely on cost, or when insurance companies prioritize profits over the best treatments for patients, there is a fundamental subordination of the doctor-patient relationship to outside interests, either corporate or governmental. This prevents patients from attaining the best care and doctors from using their professional competence to serve patients well. This is why government-controlled and oversized corporate-controlled healthcare systems subvert the doctor-patient relationship.
Another distortion occurs when patients reduce the doctor to a mere tool for treating the patient. To do so is to instrumentalize the doctor and disregard the professional competence and human dignity of the doctor. Doctors should not do whatever patients want regardless of whether it is medically indicated. This occurs when doctors are forced to do sex reassignment surgeries, prescribe contraception, perform surgical sterilizations, perform abortions, assist with suicide, euthanize people, and other procedures which do not help patients recover, but rather force doctors to violate their conscience and the nature of medicine, which is to heal and restore.
An increasingly prominent distortion is for doctors to exalt themselves such that the doctor has complete control of the patient’s care without the conscientious discernment of the patient. We must remember that the doctor-patient relationship is already tilted in favor of the doctor who has the knowledge and expertise. This, combined with the fact that the patient needs help, makes the patient vulnerable and it is tempting for doctors to let their knowledge and expertise go to their head and forget that God is ultimately in control, and that they are called to serve the patient. Doctors are not God and theirs is a ministry of service, which means that they should only administer care that is requested by patients or necessary to sustain life in emergency situations. They can give their informed judgment as a physician, but the ultimate decision is up to the patient and the patient’s family, or in cases of incapacity, a designated legal surrogate.
Doctors who refuse to work with patients unwilling to take a certain drug or who go beyond their role as a physician by telling patients that they will die are wrongly exalting themselves. They can tell patients that they cannot help them further as a physician and seek to help them alleviate suffering and encourage them, but only God decides who lives and who dies. Doctors who refuse life-sustaining care requested by patients who would benefit from this care are denying the rightful autonomy of patients and their families to direct their own course of treatment.
The focus of healthcare policy should be safeguarding and promoting the doctor-patient relationship, not subordinating it to other interests, not exaggerating the authority of patients, and not exaggerating the authority of physicians. When we see both the patient and the doctor as equally worthy of dignity and respect, while understanding that the role of the doctor is to serve the patient, we then have a solid foundation from which to build an ethical, life-affirming and economically sustainable healthcare system.
Michael Vacca is the director of ministry, bioethics and member experience at Christ Medicus Foundation (CMF) and CMF’s CURO-Health Care Fully Alive in Troy, Michigan.