Competency and the provider-patient contract

This dissertation promotes a liberal communitarian contract theory of medical ethics. It is motivated by the needs of patients and the community to have a greater participatory role in health care situations. It is also motivated by a desire to balance the interests and rights of all those who are directly or indirectly involved in the provider-patient relationship.; The author argues that many criticisms of the traditional contract theory approach to medical ethics can be dismissed, however, there is reason to be concerned over the issues of contractual individualism and minimalism. Robert Veatch's attempt to address these issues by offering a triple level social contract/covenant is found to be unsatisfactory due to its inability to adequately account for the role of incompetents in contract. Accordingly, a satisfactory theory must recognize the impact of incompetency upon the dynamics of the provider-patient relationship. In light of this, a refined version of Buchanan and Brock's account of competency is promoted.; Hugh Collin's interpretation of modern contract law suggests that contract law is (or should) be promoting fairness, trust and co-operation. His work provides the author with the template for the development of a liberal communitarian contract theory of medical ethics. This theory strives to balance the positions of the provider, the patient and the community. The community is to determine the parameters of the provider-patient relationship since it is impacted by the decisions that are made by the providers and patients. By invoking a guarded use of beneficence and a limited sense of autonomy and by promoting care when cure is impossible, we thereby reduce the concerns over individualism and minimalism.; An extensive variety of inter-related issues are featured in this dissertation including: incompetency; surrogate decision-making; advance directives; objective and subjective interests of patients; community interests; the decision-making dynamics of health care providers and patients; informed consent; the restriction or limiting of futile or unproven treatments; cost-containment; and the inclusion of nurses in the health care team. All of these issues are discussed within the setting of Canada's universal health insurance program.