A Covenant Model for the Physician-Patient Relationship

Studying the scriptures in reference to professional ethics in the context of the covenant, we can find many ideas and considerations related to the Hebrew word hesed which can be used as a guide for the ethical behavior of a provider within the physician-patient relationship.

There are many different models of the relationship that have developed out of our social needs and current financial crisis in health care (see the list at the end of this article). With the rush of managed care today, we have been left with a technical-contract model that has replaced the old paternalistic and other not-so-effective models.

As chiropractors we need to come together to share our unique experiences within our practices and develop a model that is timeless and universally moral. We need to look at our current situations to come to an understanding of how we can live out our individual faiths and morals within that context.

We can look to some of the rich meanings of hesed found in the biblical tradition. Also, we can look to its secular usage to describe what should be particular to a physician-patient relationship that holds to the patient's dignity. We need to consider how a covenant biblical model can be extended to this public-professional-interpersonal relationship.

The secular usage of hesed describes the relationship of a superior with responsibility to someone else (the recipient). This act of hesed fulfills a need for the recipient, which is something they cannot do for themselves. It appears the technical actions in the delivery of health care can fall into this type of relationship. The superior person is the physician with the knowledge and skill to help the needy recipient.

Another usage of hesed, which is similar to the secular usage, is also found in the biblical tradition. Hesed is never a special favor, but always a provision for an essential need, and an action performed by a stronger party for a weaker party. This description is what we should consider. As practitioners we are not doing patients favors when we perform an essential act for their good and for society in general. In some cases chiropractic care is not an option for the patient; it is the only service that will bring relief. By this fact, chiropractic health care providers can develop a deeper appreciation of our necessary role to serve the common good.

Another biblical meaning of hesed is divine conduct. We can look to this meaning to see how we should perform our actions. God's hesed is offered by enduring love, kindness and mercy to his people. Since we are more than just technical professionals, we need to develop a covenant relationship with the patient that has a true spiritual and human approach as its foundation. No longer can we say that we have a physician-patient relationship, if we are only relating in the contract model. We need to be whole ourselves. We are, as humans, more than our skills. We are multidimensional: physical, spiritual and mental. We need to develop a physician-hesed-patient relationship.

In one of the messages released by Pope John Paul II this March, he called for a concept of health to include attention to the patient's spiritual state. He stated, "Health includes the well-being of the whole person -- his physical, psychic and spiritual state. It also includes the circumstances of his life. The concept of health cannot be restricted to the absence of disease. Any act of assistance to a sick man should be recognized as a form of health-care work, and also as an act of charity -- ultimately, a religious act. And health-care personnel should recognize that their goal is not only to offer [treatment], but to help restore and strengthen the entire person, including his interior life, his taste for life, his joy and love and communion."

With this statement as a guide, we can see that our acts are transformed from a technical action to one of hesed. One that is offered in love and charity, with faith as a response having as our center a moral foundation rooted in holism.

Models of the physician-patient relationship that will be discussed later:

• prehistoric spiritual
• community
• ancient Western
• modern
• paternalistic
• collegial
• technological
• contract
• stranger