A return to physician beneficence in medicine through goal centric decision-making

This dissertation will contend that, in order to truly promote the best interests of the patient, it is necessary to return to an emphasis on physician beneficence in the clinic. As I will argue, a goal-centered approach is called for, in which the patient works directly with the physician and other relevant caregivers to determine what the medical goals are, and how they will be achieved. One cannot write a dissertation on physician beneficence without addressing the question of patient autonomy, especially in light of its hyper-valuation within the bioethics literature and, more broadly, American culture itself. In the clinical setting, much of the practice of medicine has been reduced to honoring the primacy of patient autonomy. Such primacy has certainly been fed by a plethora of bioethics literature, the impetus for which may have been initiated by Tom Beauchamp and James Childress in their book, "The Principles of Biomedical Ethics." As I have noted over many years of observation in the clinical setting, much of the process of medical decision-making has been diminished to the selection of interventions by the patient without the benefit of goal setting. I contend that such an activity abridges the best interests of the patient and relegates physician beneficence to a peripheral role. Further, this format sends physician beneficence to the wings until patient autonomy, as it is being practiced in the clinical setting, completes its solo performance on the stage of medical decision-making.;I maintain that this conflation of autonomy and choice within the clinic has a distinctly negative impact upon what should be understood as the concept of patient autonomy. However, and more importantly, the dominance of choice may have a deleterious effect upon the promotion of patients' best interests, at least in the medical context and perhaps more broadly. It is my claim that if the primary goal of the practice of medicine is indeed to promote patients' best interests, then physicians and patients must endorse a paradigm shift that values a return of physician beneficence to its rightful role in the context of medical decision-making specifically, and the practice of medicine more generally. I propose that the chief element of such a shift is the displacement of decision-making via "intervention-selection" by "goal centric" decision-making. Such a shift will not only engage physician beneficence as a valued partner in the process of medical decision making, but will also return patient autonomy to a more appropriate concomitant role in this human drama.