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September 4, 2002

Covenant and the Vulnerable Other

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JAMA. 2002;288(9):1133. doi:10.1001/jama.288.9.1133-JMS0904-4-1

At its best, the patient-physician relationship is not simply a contract, but a covenant. Unlike a contract, the focus of a covenant is not on rigid duties and obligations, but on what the two parties can achieve together to optimize the patient's health. The physician's responsibility is to respond with commitment, empathy, and creativity, especially when the patient's health is at risk, as in the case of the 18-year-old female African patient.

In Covenant, Community, and the Common Good, Eric Mount builds on a Jewish philosophical tradition to describe the way a covenant relationship can accommodate the "vulnerable other."1 Like the groups that Mount discusses, the stranger, the fatherless, the poor, and the widow, this woman is vulnerable in that she may face considerable harm if left to confront her situation alone. Because this patient's experience of the world is so different from that of the physician, he or she may misperceive the patient's beliefs and attitudes. Due to this "otherness," her world is "accessible only to the extent that genuine dialogue occurs."