Enemies of Patients - Hardcover

Macklin, Ruth

Hardcover

ISBN 10: 0195072006 ISBN 13: 9780195072006

Publisher: Oxford University Press, 1993

Synopsis

A young man, terminally ill and in extreme suffering, asks to be removed from life support, requesting morphine first so he'll be asleep when the machine stops. His physician agrees, but the hospital's chief administrator intervenes, arguing that the morphine might itself cause death, leaving the physician open to criminal indictment for murder. To placate the administrator, the doctor and patient reach a grim compromise: life support will be disconnected first, and only after manifest signs of suffering appear will the physician administer the morphine, to alleviate pain. The patient's request is ultimately respected, but many staff members feel he has been made to suffer needlessly.
This is just one of many cases Ruth Macklin discusses in Enemies of Patients, an eye-opening look at the growing number of forces that are hostile to the interests of patients, including hospital administrators, lawyers who represent hospitals, insurance companies, government regulations, and even some well intentioned physicians. Macklin, a highly regarded medical ethicist, the author of Mortal Choices and the subject of a New York Times Magazine cover story, provides a behind-the-scenes look at how the patient's ethical rights are often violated. She describes, for instance, how a new breed of hospital administrator, the risk manager, acts consistently as an enemy of the patient, often urging physicians to continue aggressive, expensive treatments for critically ill patients--even when the patient and doctor agree the treatment should cease--for fear of lawsuits, bad publicity, or criminal indictment. (Macklin points out, for instance, that even though no physician has ever been convicted of a crime for withdrawing treatment from a patient in a permanent vegetative state, hospital lawyers and risk managers regularly assert that there is a danger of criminal liability in such cases.) The government also can become an enemy of patients. The most egregious case, according to Macklin, is the Federal government's "gag rule" which has prohibited health care facilities that receive Title X funds from discussing abortion with pregnant women, violating the patient's right to full information. And physicians themselves can become enemies of patients. Some, seeing themselves as fiscal gatekeepers, ration expensive health care procedures on financial rather than medical grounds. Some physicians refuse to treat patients who don't follow their advice (a cardiologist, for instance, who will not take care of patients who smoke) and others won't treat patients who pose a threat of lawsuit (such as a California woman in need of life-sustaining dialysis, who had previously sued another physician).
Packed with numerous case histories drawn from the author's experience in a major urban medical center, Enemies of Patients will give readers a better understanding of their rights as patients and show them how to forge an alliance with their doctors against common enemies.

About this title

About the Author

About the Author:
Ruth Macklin is Professor of Bioethics at Albert Einstein College of Medicine. She is the author or editor of eight books, including Mortal Choices, and has published over one hundred articles in professional journals.

Reviews

Clinton's health system reform team would do well to read this study by Macklin, professor of bioethics at New York City's Albert Einstein College of Medicine--for Macklin seeks to disentangle the increasingly complicated, even adversarial relations between the medical establishment and its patients. Her account is detailed and persuasive. Although doctors appear to focus on the medical interests of patients, the author explains, doctors are often accused of being their patients' "enemies" by patient advocate groups. Further, there are other culpable forces intruding on patients' well-being, such as insurance companies and hospital management. Macklin points out that the 1973 12-point Bill of Patient Rights and the 1991 Patient Self-Determination Act helped to establish patient participation in the decision-making process, as stipulated in patients' legally binding "advance directives"--such as Living Wills and surrogate mothers. To forestall malpractice or negligence suits, hospitals have responded by hiring "risk managers" to monitor and to act as liaison agents between all parties, including families. Macklin's book could steer reformers in the right direction.
Copyright 1993 Reed Business Information, Inc.

How and why your rights as a patient are eroding as the professional autonomy of physicians has declined and the power of bureaucratic overseers has grown. The ``enemies'' of the title may be an overstatement, but Macklin (Bioethics/Albert Einstein University; Mortal Choices, 1987) has chosen the term not for precision but to emphasize the adversarial roles that may be played by, among others, hospital administrators, risk managers, insurance companies, government regulators, attorneys, judges, and even physicians. She points out that, theoretically at least, physicians are guided by two principles: beneficence, which directs them to do good; and respect for autonomy, which recognizes the right of patients to take part in treatment decisions. But although these principles may coincide, they also may conflict; furthermore, physicians' personal values may conflict with those of patients, and pressures from various hospital and governmental bureaucracies may interfere with physicians' roles as their patients' advocates, putting the doctors into the position of ``enemies.'' Macklin presents specific cases that serve as models of representative situations. Among them are cases that examine do- not-resuscitate policies; the rights of Jehovah's Witnesses to refuse life-saving blood transfusions; the conflicts between the rights of pregnant women and those of fetuses; the refusal of doctors to treat certain patients; the rights of patients competing for scarce resources; and the right to die. Many of the cases are familiar, but what is unique is the author's marvelously clear ethical analysis following each one, as she presents conflicting positions fairly and tells where she stands and why. Highly recommended for anyone concerned about the care of patients and the protection of their rights. (For a fuller discussion of physicians' obligations toward patients, see Marc A. Rodwin's Medicine, Money, and Morals, reviewed below.) -- Copyright ©1993, Kirkus Associates, LP. All rights reserved.

Edition details

• Publisher: Oxford University Press
• Publication date: 1993
• Language: English
• ISBN 10: 0195072006
• ISBN 13: 9780195072006
• Binding: Hardcover
• Edition number: 1
• Number of pages: 272