Definition of the problem
Establishing a good physician–patient relationship based on mutual trust and professional responsibility is a central element in physicians’ professionalism. Recently, however, there has been considerable debate in the field of medical ethics regarding trends toward an economic approach to medicine, which could potentially undermine healthy doctor–patient relationships. Part of this economic approach to medicine involves viewing the patient as an autonomous customer. But what does the customer role mean for vulnerable patients who are restricted in their autonomy and what effect does it have on the physician–patient relationship?
Arguments
In the following article, we pursue the question whether the physicians’ responsibility and the physician–patient relationship change when the (vulnerable) patient attributes the customer role to him-/herself. The study was conducted within the field of palliative care because terminally ill patients represent an especially vulnerable patient population. We base our argumentation in this article on the results of a qualitative interview study that investigated terminally ill patients’ attitudes regarding the topic “the patient as customer” as well as autonomy and decision-making.
Conclusion
The interview results show that autonomy must be understood in relational terms; furthermore, the analysis of the interviews indicates that the physician plays a crucial role in enabling the patient’s autonomy, regardless of whether patients view themselves as a patient or a customer. Subsequently, we deliberate whether the patients’ statements point to potential changes in the doctor–patient relationship and physicians’ responsibility towards patients. Based on these findings, practical implications for the doctor–patient relationship are considered in regard to the “Ethics of Care”, emphasizing the need for an individualized approach to working with patients, especially those with particularly vulnerable conditions.