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Bioethicist Anita Ho is researching an ethical framework that fosters greater trust and transparency in health care - photo by Martin Dee
Bioethicist Anita Ho is researching an ethical framework that fosters greater trust and transparency in health care - photo by Martin Dee

UBC Reports | Vol. 54 | No. 12 | Dec. 4, 2008

Ethicist Studies Patient-physician Trust

By Lorraine Chan
UBC bioethicist Anita Ho is trained to resolve tough dilemmas such as end-of-life care issues for families and hospitals.

An assistant professor at UBC’s W. Maurice Young Centre for Applied Ethics, Ho is also an ethicist for Providence Health Care. Each week, she attends interdisciplinary rounds at their hospitals.

Ho describes one “gut-wrenching” situation where a family insisted on tube-feeding for their father, in his 90s and at end-of-life, since he could no longer ingest solid foods.
The patient’s healthcare team advised against it since liquids could leak into his lungs and trigger infection. Despite the team’s good intentions, the patient’s son was distrustful of the hospital’s recommendation, suspecting them of withholding care.

Ho waded into this welter of charged emotions, reminding both sides to centre their decisions on the patient’s wishes and best interests. A Cantonese speaker, she was able to explain the hospital’s perspective to the family and listen to their concerns.

She then explained the patient’s cultural and family dynamics to the healthcare team, “which is concerned primarily with medical considerations, whether a treatment will improve or worsen the patient’s underlying illness.”
In the end, the team reached a compromise with the family for a less invasive procedure.

These types of interactions inform Ho’s research, which aims to develop an ethical framework that fosters greater trust, consistency and transparency.

“How do we provide the most ethical healthcare given the constraints we have?” asks Ho, explaining that current ethical guidelines place great emphasis on patient freedom and autonomy, evolving from previous eras when a more paternalistic model prevailed.

“Now, the idea is that no one can make decisions for the patient. Instead, physicians provide all relevant information and options, and support patients to decide themselves the best course of action.”

But Ho says she wonders how much control patients truly have or want. Several years ago, Ho experienced a cancer scare and medical treatment that made her test the soundness of medical ethics. Panicked, Ho told the doctors to do whatever they thought best.

“I simply trusted them and didn’t know how to decide on my own,” recalls Ho. “Nothing I had studied or written in medical ethics could prepare me for my own personal experience.”

Living in St. Paul, Minnesota at the time, Ho agreed to numerous treatments. Now back in Canada, she questions whether they were all necessary, or whether the specialists would have outlined all these options if she not been receiving healthcare under her U.S. employer’s generous insurance plan.

“Despite the current emphasis on patient autonomy,” observes Ho, “patients don’t know what’s going on in the system and don’t usually feel comfortable challenging the authority of medical expertise.”

Her current research investigates how the changes in Canada’s healthcare system are impacting the trust relationship between physicians and patients, and the public’s perception of the medical system as a whole. In its first year, Ho’s three-year study has received support from the Social Sciences and Humanities Research Council.

“The study also considers the meaning of patient autonomy when the public has little control or ownership over the medical or research enterprise,” says Ho, who also serves as associate chair for the UBC Behavioral Research Ethics Board.

Patients are experiencing a much more fragmented model of medical care than in previous decades, says Ho. People no longer expect to have one family doctor over their lifespan. Instead, they may drop into walk-in clinics or need a healthcare team of different specialists. Other dramatic changes are in the offing with increasing commercialization and privatization of medical care.

Ho conducted a preliminary survey on how much Canadians trust what their doctors tell them. The 43 respondents were outpatients from a local hospital.  She has also been conducting interviews with physicians on their perspectives.

“Most respondents seem to believe that physicians care as much about their patients’ health as the patients themselves, and that they feel comfortable asking physicians questions,” says Ho.

“However, respondents are somewhat split in their opinions of whether physicians respect patients’ disagreement. They are also split on the impact of commercialization on physicians’ judgment.”

Once Ho has gathered enough data, she hopes to publish a book-length manuscript to help clinicians, healthcare administrators and policy makers to recognize the ethical implications of various changes in the system.

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Last reviewed 03-Dec-2008

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