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January 19, 1994

Enemies of Patients: How Doctors Are Losing Their Power and Patients Are Losing Their Rights

JAMA. 1994;271(3):247. doi:10.1001/jama.1994.03510270093052

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Enemies of Patients, by Ruth Macklin, is a well-constructed four-wheel— drive vehicle for a journey through the briar patch of ethics and medicine. Macklin uses the case study method to illustrate each of her main points, and the result is a well-thought-out and very thought-provoking exploration of a difficult subject.

The medical curriculum of my era (class of 1963) had no teaching on the ethics of medicine. Nor did we have the technology or expertise to create Quinlan-type dilemmas, nor the myriad second guesses of bioethicists, plaintiffs attorneys, quality assurance committees, risk managers, and the like. Then, physicians did what they felt was best for the patient. Now, in the words of the late Jimmy Durante, "everybody wants inta da act!" The author calls the prior method "paternalism" in her book, but she also clearly points out the two ancient and honorable obligations of physicians, "to promote their patients' best

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