tag:blogger.com,1999:blog-7476621888383604834.post8942391851337201207..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Medical Ethics and Blaming the VictimJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7476621888383604834.post-36956422326247883732012-01-21T10:31:06.251-05:002012-01-21T10:31:06.251-05:00Hello Douglas -
Thank you for this very thoughtfu...Hello Douglas -<br /><br />Thank you for this very thoughtful comment. I agree completely with your analysis of the implications and complexities of assigning responsibility.<br /><br />In my practice I learned most about this area from my substance abuse specialist colleagues, my patients with drug and alcohol problems, and from attending a number of AA meetings. As I understand it, AA starts with acceptance of "non-responsibility" (Step 1 - "we admitted we were powerless over alcohol") and gradually works to take on progressively more responsibility (Step 12 - "we tried to carry this message to alcoholics, and to practice these principles in all our affairs"). Although the "alcoholism is a disease" model explicitly precludes blaming the person with alcoholism, AA aphorisms emphasize responsible activism, as in "reach for the telephone, not for the bottle."<br /><br />Your point about how blame can impede empathy is VERY important and wise. In that domain I've found the teaching - "let he who is without sin cast the first stone" - especially useful.<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-64199601031537248782012-01-20T11:26:05.102-05:002012-01-20T11:26:05.102-05:00I believe the assignment of responsibility has dee...I believe the assignment of responsibility has deep, but often poorly recognized implications for patient care. There is some evidence that clinicians who hold the patient responsible for the clinical problem have more difficulty forming empathetic relations with the patient. However, even more telling is the way in which we equate responsibility with empathetic feeling in everyday speech. If I ask a companion how they feel about the situation of a mutual friend and the response is, “He brought it on himself,” I will understand clearly, how my companion feels about our mutual friend – although no feelings have been mentioned.<br /><br />This results in an even more insidious problem. There can be an inclination toward mitigating a patient’s real responsibility for unhealthy behaviors to allow ourselves, as caring clinicians, more access to empathetic feelings. When this happens, the clinician may be colluding with the patient to shut off important avenues in coming to grips with unhealthy behaviors<br /><br />If we take concept that clinical relations are an essential aspect of ethical treatment seriously, then clinicians need to monitor this impulse carefully. The potential harm of the impulse to allow judgments to affect our clinical relationships is magnified by the nature of current practice. Much of the morbidity and mortality in the US is due to poor health behaviors. Mokdad et al. (2004) report that in 2000 tobacco, poor diet and exercise, and alcohol, were the top three causes of death in 2000 accounting for 38% of deaths.<br /> <br />Mokdad, A., Marks, S., Stroup, D. & Gerberding, J. (2004). Actual Causes of Death in the United States, 2000. JAMA, 291(10), 1238-1245.Douglas Olsenhttps://www.blogger.com/profile/16782839923012641263noreply@blogger.com