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Jeffrey D. Tiemstra, MD
Galva, Ill

JAMA. 1988;259(4):517.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Although I agree with Dr Pellegrino's¹ unstated purpose of urging physicians to altruism, I disagree with his assertion that such behavior is an obligation of the profession.

He first states that the patient must "trust the physician in a relationship of relative powerlessness." This paternalistic view of the physician-patient relationship has been replaced by a contractual model, where both parties have rights and responsibilities. The contractual model is superior to the paternalistic one in that it preserves the patient's integrity as a human being, but it also implies that the physician, like the patient, can terminate that relationship (reasonably) or refuse to enter into it.

Dr Pellegrino next claims that medical education is a trust bestowed on the physician by society. While this is true, it is no less true of all professions and trades. Lawyers, businessmen, and plumbers all inherit the accumulated knowledge of their . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Senior Contributing Editor; Sharon Iverson, Assistant Editor.

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