For most of human history and across multiple cultures, ethical behavior has been guided by the Golden Rule. When we act with empathy and compassion, we build on this important principle. But the rules are incomplete. People have very different values, lived experiences, and senses of what is acceptable. What you want in a given situation may not be what someone else wants at all.
The risks of deciding or influencing the choices of others can be particularly high in the medical field. Such choices affect people’s quality of life and even their chances of survival. As health care becomes less paternalistic and more individualized, the time seems ripe for new ethical guidelines. Enter the proposed “Platinum Rule”.
Palliative care expert Chochinov explains this principle eloquently in her essay “Seeing Ellen and the Platinum Rule,” published last year. Department of Neurology, JAMAHe begins with a story about a health crisis affecting his deceased sister, Ellen, who is severely disabled by cerebral palsy. The intensivist managing her case, seeing her contorted body and difficulty breathing, asked Chochinov a strange question as he considered whether to insert a breathing tube: Did you read magazines? “The subtext was chilling,” writes Chochinov. Her brother, Ellen, read extensively and enjoyed life’s many simple pleasures But the chasm between her life as a frail person in a wheelchair and her doctor’s sense of what he wanted in her situation was too great and the golden rule .
“When someone else’s lived experience, their sensibilities and perspectives differ greatly from your own, it uses itself as this infallible barometer of what others need or want. “It’s time,” Chochinov explained to me. “We have to acknowledge the way our own personal biases shape the way we perceive and respond to patients.”
These patients may differ from healthcare professionals in more than their abilities and disabilities. Their values may also be shaped by race, culture, and experience. In diverse societies, doctors should not project their values and beliefs onto patients, presenting them “as if they were blank screens or clones of themselves.” Kathryn Frazee, Emeritus Professor of Disability Studies at the University of Toronto and Disability Advocate. Metropolitan University. The practitioner is “well-educated, respected and well-paid. These three things make him look at the world differently. So there is real prejudice.”
The Platinum Rule is nothing new. In medicine, however, it summarizes current thinking about patient autonomy, equity, and diversity, and is considered to be a “very good” and concise formulation, suitable for teaching healthcare professionals. says Joseph Finns, a medical ethicist at Weill Cornell Medicine.Indeed, within a few weeks of writing about the idea Department of Neurology, JAMA and Journal of Palliative MedicineChochinov began hearing about its adoption at medical ethics conferences, and eventually in other journal articles.
Trying to understand a patient’s individual needs and wishes does not mean addressing them all. Medicine cannot be a “take-home service,” says Chochinov. “Not every patient can always receive everything. That’s the reality of living in a healthcare system where resources are limited.” One of the limited resources, he said, is time. It is undeniable that knowing a patient as an individual rather than a common host of illnesses means investing an extra minute or hour. Still, Fins believes such investments are usually cost-effective.
Clinicians also benefit. “When doctors connect emotionally with their patients, they do a better job,” Chochinov says. “And we have data that shows greater job satisfaction and less burnout.”
Clinicians may find it difficult to apply the platinum rule when patients are unable to speak for themselves and loved ones are unsure of their wishes. , the effort is worth it.
