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"The fixed person for fixed duties, who in older societies was such
a godsend, in the future ill be a public danger." Twenty years ago,
a single legal metaphor accurately captured the role that American
society accorded to physicians. The physician was "c- tain of the
ship." Physicians were in charge of the clinic, the Operating room,
and the health care team, responsible - and held accountabl- for
all that happened within the scope of their supervision. This grant
of responsibility carried with it a corresponding grant of
authority; like the ship's captain, the physician was answerable to
no one regarding the practice of his art. However compelling the
metaphor, few would disagree that the mandate accorded to the
medical profession by society is changing. As a result of pressures
from a number of diverse directions - including technological
advances, the development of new health professionals, changes in
health care financing and delivery, the recent emphasis on consumer
choice and patients' rights - what our society expects phy- cians
to do and to be is different now. The purpose of this volume is to
examine and evaluate the conceptual foundations and the moral imp-
cations of that difference. Each of the twelve essays of this
volume assesses the current and future validity of the "captain of
the ship" metaphor from a different perspective. The essays are
grouped into four sections. In Section I, Russell Maulitz explores
the physician's role historically.
The first time I read the medical consent and authorization. it had
registered in my mind simply as a legal document. Now I began to
understand what it meant. It was a letter of ultimate love and
trust. (Schucking. 1985. p. 268) Ever since Karen Ann Quinlan
slipped into permanent unconsciousness in 1975 and her father
agonized publicly over whether she should remain indefinitely on a
respirator (In re Quinlan, 1976), the desires of patients, their
families, and their friends to limit the application of apparently
limitless medical technology have been a pressing concern for
ethics, law, and public policy. Ms. Quinlan's case contained nearly
all the elements of the problems we still face: vague, general, but
sincere prior oral statements suggesting that she would not want
continued treatment; a family attempting to do what they saw as
best for her; and physicians uncertain whether to use medical
judgment alone (and if so, what the "right" medical decision was),
to preserve her life at all costs, or to honor the family's
interpretation of their daughter's choice. Most ironically, once
she was removed from her respirator, she did not die. Karen Quinlan
- like dozens of other names made famous by court decisions,
newspaper stories, and television evening news - has come to
symbolize a tangled knot of issues surrounding the end of life and
who controls it.
"The fixed person for fixed duties, who in older societies was such
a godsend, in the future ill be a public danger." Twenty years ago,
a single legal metaphor accurately captured the role that American
society accorded to physicians. The physician was "c- tain of the
ship." Physicians were in charge of the clinic, the Operating room,
and the health care team, responsible - and held accountabl- for
all that happened within the scope of their supervision. This grant
of responsibility carried with it a corresponding grant of
authority; like the ship's captain, the physician was answerable to
no one regarding the practice of his art. However compelling the
metaphor, few would disagree that the mandate accorded to the
medical profession by society is changing. As a result of pressures
from a number of diverse directions - including technological
advances, the development of new health professionals, changes in
health care financing and delivery, the recent emphasis on consumer
choice and patients' rights - what our society expects phy- cians
to do and to be is different now. The purpose of this volume is to
examine and evaluate the conceptual foundations and the moral imp-
cations of that difference. Each of the twelve essays of this
volume assesses the current and future validity of the "captain of
the ship" metaphor from a different perspective. The essays are
grouped into four sections. In Section I, Russell Maulitz explores
the physician's role historically.
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