The "Difficult" Patient Reconceived: An Expanded Moral Mandate for Clinical Ethics

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Center for Bioethics Papers
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bioethics
clinical ethics
medical ethics
Bioethics and Medical Ethics
Medicine and Health Sciences
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Between 15%-60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses to problematic interactions related to healthcare delivery. If there are grounds to reconceive the “difficult” patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.

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2012-05-01
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The American Journal of Bioethics
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This is an Accepted Manuscript of an article published by Taylor & Francis in the American Journal of Bioethics in January 2012, available online: http://wwww.tandfonline.com/doi/10.1080/15265161.2012.665135.
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