Page 49 - Contribution To Phenomenology

42 RICHARD M ZANER

In other words, the usual boundaries of a person, both physical and
emotional, are crossed with impunity by physicians ([3, I], p. 119).

Or consider Edmund Pellegrino and David Thomasma's emphasis that the
ground for an ethics of trust—the heart of the "clinical event"—is the
patient's "existential vulnerability." Although primarily focused on the
patient's threatened organic systems (disease, injury, handicap), that very
vulnerability obligates the physician to be cognizant of and to respect the
patient's moral agency—an obligation that increases as the invasiveness
of medical procedures increases. Thus, when they contend that "it is the
body of the patient that grounds this obligation, not merely social and
legal structures," it cannot be ignored that this "body" is the specific
embodiment of this or that specific person. While a patient's "body is
probed and violated in closer proximity and more intimately than is
usually permitted even to those the patient loves" ([24], p. 185), it is that
patient herself who is "probed and violated."
In any event, one prominent characteristic of the physician-patient
relationship is its asymmetry. Although the relation is in a sense
reciprocal, it is unbalanced with power on the side of the physician: the
physician, not the patient, has knowledge (about pregnancy, fetal
development), technical skills (delivery, cephalocentesis, c-section), access
to resources (ultrasound, operating room), social legitimation and legal
authorization (license to practice medicine) [18]. Patients do not have this
range of knowledge and skills, access and legitimation. Moreover, very
often they do not even know how to assess whether the professed healer
is capable of healing or how to assess the abilities of those who profess
to have them. Patients are thus existenrialfy vulnerable not only by virtue
of their bodily conditions, but also by the relationship's asymmetry.
On the other hand, the relationship invariably involves profound
intimacies regarding the body, the self, the family, their particular lives,
beliefs, and circumstances. As the relationship is most often among
strangers, furthermore, the asymmetry and intimacy of contact can be
especially tense, trust often problematic, and treatment open to com-
promise.

III. Morality and Power

These reflections suggest that the physician-patient relationship is
distinctively valorized: medicine is an inherently moral enterprise [2].