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Article
May 17, 1995

Patient-Physician Covenant

Author Affiliations

Dr Crawshaw is in private practice in Portland, Ore; Dr Rogers, who died December 5, 1994, was the Walsh McDermott University Professor of Medicine at the New York Hospital-Cornell Medical Center; Dr Pellegrino is Director, Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC; Dr Bulger is President, Association of Academic Health Centers, Washington, DC; Dr Lundberg is Editor, JAMA, Chicago, Ill; Dr Bristow is President-Elect, American Medical Association, Chicago, Ill; Dr Cassel is Section Chief, Department of Internal Medicine, University of Chicago, Chicago, Ill; and Dr Barondess is President, New York Academy of Medicine, New York, NY.

JAMA. 1995;273(19):1553. doi:10.1001/jama.1995.03520430089054
Abstract

Medicine is, at its center, a moral enterprise grounded in a covenant of trust. This covenant obliges physicians to be competent and to use their competence in the patient's best interests. Physicians, therefore, are both intellectually and morally obliged to act as advocates for the sick wherever their welfare is threatened and for their health at all times.

Today, this covenant of trust is significantly threatened. From within, there is growing legitimation of the physician's materialistic self-interest; from without, for-profit forces press the physician into the role of commercial agent to enhance the profitability of health care organizations. Such distortions of the physician's responsibility degrade the physician-patient relationship that is the central element and structure of clinical care. To capitulate to these alterations of the trust relationship is to significantly alter the physician's role as healer, carer, helper, and advocate for the sick and for the health of all.

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