THE DIGNITY of the HUMAN PERSON in HEALTH CARE: PATIENTS as AGENTS

We often use the word “patient” when speaking of men and women who are receiving medical care without giving much thought to what that word means. That is not necessarily a problem. The word “patient” is a helpful signifier in the context of health care. Everyone knows who is being referred to. Nevertheless, it is good for us to examine the meaning of this word and what it might imply about the human persons to whom it is applied.

The word “patient” comes from a Latin word (pati, patior) that means, “to permit, undergo, or suffer,” the same word that is the root of the English word “passive.” To be a patient, according to the original meaning of the word, is to be a passive recipient of someone else’s action. In this sense, being a patient is the opposite of being an agent. An agent is one who acts. A patient is one who is acted upon.

It is easy to see why the word “patient” came to designate a person who receives medical care. Such a person is a passive recipient of the actions of medical professionals. Doctors, nurses, and technicians act; patients are acted upon. Medical professionals give medical care; patients receive it.

All of that is well and good. A problem arises, however, when we identify the person with the role he or she plays in the exchange of medical care. A man may be a passive recipient of a surgical procedure. In that instance, the surgeon acts and the man is acted upon. He is a patient. But what cannot be forgotten is that he is also a man. To put it another way, the man, as a patient, is the object of the surgeon’s action. The man, however, cannot be reduced to a mere object. He is also a subject of his own actions and must be treated with the dignity of a human subject. He is a patient. What must not be forgotten, however, is that he is also an agent.

The fact that patients are also agents has, in some ways, gained greater recognition in contemporary medical practice. This development is reflected in things like patient’s bills of rights, patient advocates, laws and policies protecting patient privacy, and various forms of advanced directives seeking to insure that patients’ wishes are respected. Medical ethicists have also emphasized the right of patients to be agents of decision making for their own medical care. The principle of autonomy is often invoked in advocating for this right.

Despite these positive developments, however, there are other ways in which contemporary medical practice militates against the recognition of patients as human subjects. It does this, I would suggest, by making it more difficult for medical professionals to know their patients as human beings.

Contemporary medical practice has become increasingly specialized and increasingly corporate. Specialization means that patients are more likely to have multiple doctors and doctors are more likely to be responsible for only part of a patient’s care. Specialized medicine certainly has great benefits. It allows doctors to have greater knowledge and competency in their areas of specialty. Nevertheless, specialized medicine makes it less likely that doctors will have comprehensive knowledge of their patients’ overall medical condition. Not knowing their patient’s whole medical picture, doctors are less likely to know their patients as whole persons. Specialization also means spending less time with more patients, making it more difficult for doctors to appreciate the human dignity of every person in their care.

The increasingly corporate nature of medical practice is evidenced by the increasing number of physicians working in hospitals and hospital-owned practices. The shift toward practicing medicine in larger institutions means that doctors and other medical professionals are more likely to be caring for patients who come from greater distances and less likely to care for patients they see frequently and know personally. The growing influence of corporate structures, insurance companies, and government mandates also mean that policies and priorities governing medical practice are more and more being determined by people who are not directly involved in caring for the health of patients. Excessive interest in bottom lines, time spent in computerized charting, and concern for efficiency can make it more difficult for clinicians to know and treat their patients as agents: human subjects with personal dignity.

When doctors and other health care professionals do not know their patients as human beings, they are less inclined to think of their patients as human beings and less disposed toward treating their patients as human beings. It is therefore imperative that they deliberately counteract the factors in contemporary medical practice that militate against knowing patients as human subjects. Health care professionals need to be reminded, and to remind themselves, that the human persons in their care are agents as well as patients, subjects as well as objects, and deserve to be treated with the respect and dignity that is rightly theirs.