Our Rights, Our Responsibilities
Jeremy Baruch, MD, Department of Psychiatry; Associate Director of University of Michigan Medical Program on Health, Spirituality and Religion, University of Michigan
There is an extensive literature on “patient rights” ensuring the distribution of rights to all patients. This literature is most relevant to the way we care for some of our most challenging patients, such as those who lack decisional capacity or who may be aggressive. The entrenchment of the concept of patient rights is a victory for all who care about creating an inclusive healthcare system.
The concept of patient rights raises challenging questions. On what basis do people have rights? Assume that rights are ascribed on the basis of an individual’s value. On what basis do we assess value? One may be inclined to ascribe value on the basis of abilities: moral reasoning, intellectual ability, athleticism or any other utilitarian assessment of an individual's ability to contribute to society. The ability to contribute to society is essential to human flourishing and development - but is it the basis upon which we ascribe rights?
No one achieves excellence or has abilities in all domains of human activity. Those often protected by patient rights may not excel in any activities at all. There is a risk that our capitalist economic model will bleed into our moral reasoning. Valuing productivity, we may unconsciously feel that those who do not produce are not of equal value. As “enlightened” people we nevertheless protect their lives and ascribe them “rights” on the basis of our nobility and generosity.
What is the problem with conceptualizing care for our most vulnerable patients as a noble act of generosity? It is based on a hierarchical concept of worth in which those with greater value care for the weak on the basis of an ethic of charity toward the “other.” The idea that the vulnerable patient receiving care is as worthy of care as the medical provider becomes obfuscated.
When Genesis describes humans as being created in God’s image, it is anticipating that we will have difficulty relating to each other in this way (see: relations between Cain and Abel until present day conflicts). Sharing in God’s image is descriptive of every human regardless of what they do with their time on earth.
When you and your vulnerable patient fundamentally have equal value derived from sharing equitably in “God’s image” - caring for the vulnerable can no longer be conceptualized as an act of charity or generosity.
You likely feel that you, your family, and friends have a right to medical care. You would not consider your medical care to be an act of generosity on the part of the provider. You would also never consider that you only deserve medical care on the basis of your abilities. What is true for use is equally true for our vulnerable patients who are captured in the “patient rights” literature.
This paper will explore how changing our perspective around the patient rights can transform our practice of medicine. I will describe the ways a practice rooted in humility, followed by joy, can emerge from such a paradigm shift.
The concept of patient rights raises challenging questions. On what basis do people have rights? Assume that rights are ascribed on the basis of an individual’s value. On what basis do we assess value? One may be inclined to ascribe value on the basis of abilities: moral reasoning, intellectual ability, athleticism or any other utilitarian assessment of an individual's ability to contribute to society. The ability to contribute to society is essential to human flourishing and development - but is it the basis upon which we ascribe rights?
No one achieves excellence or has abilities in all domains of human activity. Those often protected by patient rights may not excel in any activities at all. There is a risk that our capitalist economic model will bleed into our moral reasoning. Valuing productivity, we may unconsciously feel that those who do not produce are not of equal value. As “enlightened” people we nevertheless protect their lives and ascribe them “rights” on the basis of our nobility and generosity.
What is the problem with conceptualizing care for our most vulnerable patients as a noble act of generosity? It is based on a hierarchical concept of worth in which those with greater value care for the weak on the basis of an ethic of charity toward the “other.” The idea that the vulnerable patient receiving care is as worthy of care as the medical provider becomes obfuscated.
When Genesis describes humans as being created in God’s image, it is anticipating that we will have difficulty relating to each other in this way (see: relations between Cain and Abel until present day conflicts). Sharing in God’s image is descriptive of every human regardless of what they do with their time on earth.
When you and your vulnerable patient fundamentally have equal value derived from sharing equitably in “God’s image” - caring for the vulnerable can no longer be conceptualized as an act of charity or generosity.
You likely feel that you, your family, and friends have a right to medical care. You would not consider your medical care to be an act of generosity on the part of the provider. You would also never consider that you only deserve medical care on the basis of your abilities. What is true for use is equally true for our vulnerable patients who are captured in the “patient rights” literature.
This paper will explore how changing our perspective around the patient rights can transform our practice of medicine. I will describe the ways a practice rooted in humility, followed by joy, can emerge from such a paradigm shift.