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September 16, 1992

Models of the Physician-Patient Relationship

Author Affiliations

Michigan State University East Lansing

JAMA. 1992;268(11):1411-1412. doi:10.1001/jama.1992.03490110048020

To the Editor.  —Emanue1 and Emanuel1 argue for a "deliberative" model of the physician-patient relationship. The model conceives of patient autonomy as the capacity for moral self-development in matters of health. It holds that the "aim of the physician-patient interaction is to help the patient determine and choose the best health-related values." How? By presenting information, by helping the patient clarify the values at stake, and then by articulating what should be done and persuading the patient."Deliberation" is an attractive way to think of the physicianpatient conversation. It suggests rationality and responsibility; it suggests that the two parties, together, think something through. The details of their model, however, do not fit comfortably with their formal ideal.Moral reasoning, like any kind of thinking, is fostered in a variety of ways. Telling someone the answer and how to reach it is not the most important of these, except when