The Ethics of Perowne’s Relationship with Baxter

The relationship between a doctor and a patient is a moral one, as a doctor cares for his patients and attempts to relieve their suffering, much like the relationship between a parent and a child. In Saturday by Ian McEwan, Perowne’s relationship with Baxter brings up a major ethical debate over patient-physician relationships.

Essentially, Perowne established a patient-doctor relationship in my opinion by diagnosing Baxter and then providing advice on possible treatments, even though the treatments were falsely constructed.

In order to find some guidelines on medical ethics standards, I read the Code of Medical Ethics from the American Medical Association. I found some evidence to support that Perowne made an ethical decision, while other evidence undermines such a claim.

Under the fundamental elements of a patient-physician relationship, the AMA claims that “The patient has the right to courtesy, respect, dignity, responsiveness, and timely attention to his or her needs.”  Courtesy, respect, and dignity were far from Perowne’s mind when he attempted to intimidate Baxter by publicly proclaiming he was a victim of Huntington’s disease.   Though one could claim that Perowne had Baxter’s health as his utmost motive, his situation was not so timely that it needed to be brought up in front of all of his friends. Perowne could have just as easily said something in private if he had a true concern.

Furthermore, patients have a right to confidentiality, “unless information is provided for by law or by the need to protect welfare of the individual or the public interest.”  Baxter’s condition was of no interest to the overall public well-being at the time, and it certainly was not warranted by law.

Yet the root of the debate really lies in the overarching statement that a “doctor has an ethical obligation to place a patient’s welfare above his or her own self-interest and above obligations to other groups.”  (http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion10015.shtml) The interactions immediately following the traffic accident seem to be motivated by Perowne’s selfish will to protect himself, but his decision on the surgery is much more cloudy.

When Perowne makes the decision to operate on Baxter, it seems as though he may be doing so to as an attempt to redeem his callous behavior towards Baxter previously.  When Dr. Jay calls Perowne in to operate, he clearly thinks it is in Baxter’s best interests to have Perowne operate. However, if he were presented with the full truth of the events that had transpired earlier in the day, he might have changed his mind.  By withholding that information from Jay, Perowne is selfishly reserving his right to remedy his inner emotions.

Ultimately though, Perowne ends up saving Baxter’s life, and most would agree that it is in the patient’s best interest to survive. With any slight error, the situation could have turned out completely differently.  In retrospect, it’s easy to agree with Perowne’s decision as the outcome was favorable.  However, at the time of the decision, it seemed much more questionable.

Overall, the job of a doctor is often a job of decisions. Doctors are only human, and they must do their best with the resources given to them to make their own judgments.  Keeping the best interests of the patients in all decisions is absolutely vital, and I have doubts that such interests were Perowne’s ultimate concern.

-Laura Dolbow

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~ by lauradolbow on March 31, 2010.

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