title: Chronic illness and the physician-patient relationship: a response to the Hastings Center's "ethical challenges of chronic illness".
abstract: The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care.
authors.affiliation: Mount Sinai Medical Center, New York, New York 10029-6574.
authors.forename: D A
authors.initials: DA
authors.lastname: Moros
authors.forename: R
authors.initials: R
authors.lastname: Rhodes
authors.forename: B
authors.initials: B
authors.lastname: Baumrin
authors.forename: J J
authors.initials: JJ
authors.lastname: Strain
mesh_terms: D001294:Attitude to Health; D002908:Chronic Disease / Q000628:therapy*; D032982:Contracts; D004992:Ethics, Medical; D015276:Health Care Rationing; D006801:Humans; D008134:Long-Term Care; D028681:Moral Obligations; D026706:Paternalism; D018579:Patient Selection; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D040841:Resource Allocation; D012935:Social Justice; D014481:United States