yentive medicine and risk-reduction in health care, not to engage in determine whether they are desirabl terventions, physicians often attempt deliberation or to revise their affirm, upon reflection these values as persuade patients to adopt particular m Finally, like the interpretive ones that should justify their actions; health-related values. Physicians fire- model, the deliberative model may eas- and then be free to initiate action to quently urge patients with high choleg- ily metamorphose into unintended pa- realize the values. The process of de- erol levels who smoke to change their termalism, the very practice that gen- bration integral to the deliberative dietary habits, quit smoking, and begi rated the public debate over the model is essential for realizing patient exercise programs before initiatingdrug proper physician-patient interaction Second, our society simage of an ideal therapy. The justification given forthese THE PREFERRED MODEL AND THe physican is not limited to one who knows changes is that patients should value their health more than they do. Simi- PRACTICAL IMPLICATIONS larly, physicians are encouraged to per- Clearly, under different clinical cir- vant factual information and compe a 1 rus(HIvh-infected patients who might propriate. Indeed, at different times all tions. The ideal physician-often em oe engaging in unsafe sexual practices four models may justifiably guide phy- bodied in lterature, art, and popular eithertoabstainor, realistically, to adopt sicians and patients. Nevertheless, it is culture-is a caring physician who in "safer sex"practices. Such appeals are important to specify one model as the tegrates the information and relevant :n, not made to promote the HIV-infected shared, paradigmatic reference: exce values to make a recommendation and patient's own health, but are grounded tions to use other models would not be hrough discussion on an appeal for the patient to assume automaticaily condemned, but wouidre- suade the patient to accept this recom- responsibility for the good of other. quire justification based on the circum- mendation as the intervention that best Consequently, by excluding evaluative stances of a particular situation. Thus, promotes his or her overall well-being judgments, the interpretive model it is widely agreed that in an emergency Thus, we expect the best physicians to seems to characterize inaccurately ideal. where delays in treatment to obtain in- engage their patients in evaluative dis- physician-patient interactions. formed consent might irreversibly harm cussions ofheaith issues and related val- the patient, the paternalistic model cor- ues. The physician's discussion does not OBJECTIONS TO THE rectly guides physician-patient interac- invoke values that are unrelated ortan DELIBERATTVE MODEL The fundamental objections to the de- clear but conflicting values, the interpre- and potential therapies. Importantly, 1 lberative model focus on whether it is tive model is probabiy justified. For in- these efforts are not restricted to situ- roper for physicians to judge patients' stance, a 65-year old woman who has ations in which patients might make"ir related values. First, physicians do not Early decided against reinduction che- tend to all health eare decision at ex- alues and promote particular health- been treated for acute leukemamay have rational and harmful"choices-bt possess privileged knowledge of the pri- motherapy if she relapses. Several Third, the deliberative model is not a orsv othealth-related vaiues relative to nths before the anticipated birth ofher disguised form of paternalism. Previ nther values. Indeed, since ours is a Erst grandchild, the patientrelapses. The ously there may have been category mis iuralistic society in which people es- patient becomes torn about whether to takes in which instances of the deliber- pouse incommensurable values, it is endure the risks of reinduction chemo- ative model have been erroneously iden likely that a physician, s values an therapy in order to live to see her first led as physician paternalism, And no of which values are higher will grandchild or whether to refuse therapy ubt, in practice, the deliberative phy with those of other physicians an ning herseif to not seeing sician may occasionally lapse into pa of his or her patients child. In such cases, the physician may termalism. However, like the ide Second, the nature of the moral de- justifiably adopt the interpretive ap- teacher, the deliberative physician at- liberation between physician and pa-.. proach. In other circumsta where mpts topermuade the patient ofthe tient, the physicians recommended in- there is only a one-time physician-patient thiness of certain vaiues, not to impos terventions, and the actual treatments interaction without an ongoing relation. those values paternalistically; the rticularphysiciantreatingthe patient. elucidated and compared with ideals, his or herwill, but to persuade the patient rovided to patients shouid not depend tive model may be justified the informa- Laws, Plato characterizes this funda- on the physician's judgment of the wor. Descriptively and prescriptively, we mental distinction between persuasion i thiness of the patient' s vaiues or on the claim that the ideal physician-patient and imposition or medical practice that bioethicist put it We will adduce six points to justify this paternalistic model d: therefore the physician must re- nearly embodies our ideal of autonomy. any account of his illne ng autonomy shion of a dictator [Alt the level of clinical person to select. nrestricted by coer. physician, who usually cares for free men, practice. medicine should be value-free in cion, ignorance, phy ieal interference, treats their diseases rst by thoroughly dis- the sense that the personal values of the and the like, his or her preferred course cussing with the patient and his friends his