Fidelity to the healing relationship: a medical student's challenge to contemporary bioethics and prescription for medical practice

Abstract

As a medical student, I observed that different physicians had strikingly different attitudes and approaches when caring for patients. The care of one patient in particular continues to challenge my understanding of illness and moral responsibility in the practice of medicine. In this paper, I illustrate the care of this patient in order to evaluate the dominant ethics I was taught in medical school, in theory and in practice, and argue neither principlism nor the ethics of care fully captures the moral responsibility of physicians. Emphasising fidelity to the healing relationship, a core principle derived from Pellegrino's virtue theory, I conclude that this approach to clinical ethics fully explains physician responsibility. Pellegrino deconstructs the practice of medicine to clarify the moral event within the clinical encounter and offers a sufficiently useful and justified approach to patient care.

Character Strengths Profiles in Medical Professionals and Their Impact on Well-Being

“…Summarizing historical and modern literature, some virtues recur. In particular, compassion was discussed oftentimes to play a central role (e.g., Lopez and Dyck, 2009;Gelhaus, 2012;Aramesh, 2017) as well as courage (e.g., Shelp, 1984;Fugelli, 1999;Begley, 2008), altruism (e.g., Bishop and Rees, 2007), humility (e.g., Coulehan, 2011;DuBois et al, 2013), hope (e.g., Bryan, 2007;Miller, 2012), and practical wisdom (e.g., Corcoran et al, 2016;Bain, 2018). Professionalism in other countries or cultures is partially focusing on other values like in Korea, where physicians evaluated duties (e.g., responsibility, veracity) to be of higher importance than virtues (e.g., altruism; Kim and Choi, 2015).…”

The ethical principles and caring behavior of Indonesian nurses

“…Furthermore, fidelity creates an environment for achieving goals of care and services. 37 The principle of fidelity that many nurses do in this study is keeping promises when educating patients, providing information about the patient's condition to other health workers, and involving patients in developing nursing plans. This principle requires nurses to treat all patients with respect, which is not always easy, specifically when patients are disagreeable, uncooperative, or rude.…”

Institutional Courage in Healthcare: An Improvement Project Exploring the Perspectives of Veterans Exposed to Airborne Hazards

“…Such an inquiry might help inform improvement in veterans' experiences with the service connection process and VA healthcare. Similarly, the fidelity rule establishes that providers must adhere to the principles of the healing relationship [53]. At the macro level, veterans also view the service connection process as keeping the promise made when they enlisted in the military.…”