A new principle in medicine focuses on understanding patients’ values, not assuming they share your own.
For much of human history and across multiple cultures, ethical behavior has been guided by the Golden Rule: do unto others as you would have them do unto you. When we act with empathy and compassion, we draw on this cherished principle. But the rule is imperfect. People vary greatly in their values, lived experiences and sense of what is acceptable. What you would want in a given situation may not be what another person desires at all.
Chochinov, an expert on palliative care, eloquently describes this principle in his essay “Seeing Ellen and the Platinum Rule,” published last year in JAMA Neurology. He begins with a story about a health crisis affecting his late sister Ellen, who was severely disabled by cerebral palsy.
Those patients can differ from health-care workers by more than their abilities or disabilities. Their values can also be shaped by race, culture and experience. In a diverse society, doctors ought not project their values and presumptions onto the patient “as if the patient were a blank screen or clone of the doctors themselves,” observes Catherine Frazee, a disability advocate, author and emerita professor of disability studies at Toronto Metropolitan University.
Making the effort to understand a patient’s personal needs and wishes does not mean catering to all of them. Medicine can’t be “a take-out service,” Chochinov says. “Not all patients can receive all things at all times. That’s the reality of living with a health-care system that has limited resources.
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