Nurse Skeptical's Retort
Nurse Skeptical's response to the above interpretation of the scenario is likely to be quite defensive, and a defense of her actions and decisions would not be entirely without grounds. If there was indeed a psychological problem that Mrs. testy was experiencing, it would render her incapable of autonomy at least in the very limited regard of her requests for pain medication. The very essence of a psychologically-induced feeling of pain is that the patient cannot differentiate between a psychological and a physiological symptom, and thus cannot accurately report the pain to their medical professional. Furtehrmore, should the placebo that Nurse Skeptical plans on administering prove equally successful in "treating" the "pain," her actions would seem entirely justified.
This defense overlooks several key factors necessary to the proper provision of medical care, however. First and foremost, there is at least some possibility that the pain Mrs. Testy is experiencing is a physiological and not a psychological symptom, meaning that the two-week course of placebos rather than pain killers suggested by Nurse Skeptical and approved by the attending physician carries a strong possibility of causing undue and unethical discomfort to the patient for no good reason. Second, there should be no barrier in approaching Mrs. Testy and informing her that the pain appears to be unrelated to her primary condition, and suggesting psychological treatment as an alternative or an addition to the pain medication. The placebo course would fail to treat the underlying psychological issue anyway, and psychological treatment would be eventually indicated.
Hurting the Professional: an Alternative View
There are, of course, many other interpretations and explanations of the scenario at hand available in the literature. One such explanation would essentially toss out the notion of an explicit professional-client relationship type at work here, and suggest that Nurse Skeptical's actions and decisions are a response to hurt inflicted on her by the client (Andre 1994). Professionals in the medical field often (hopefully...
Testy's pain as a result of her primary condition could possibly lead to the conclusion reached in the scenario that the pain was unrelated to the condition. Though the eventual effects of the decision on the professional-client relationship are the same, the causes are profoundly different.
This view acknowledges Nurse Skeptical as equally dependent on the professional-client relationship for her own sense of personal and professional well-being, as her status is defined by the level of care (and possibly the level of appreciation) perceived and experienced by Mrs. Testy (and evinced towards Nurse Skeptical). As such, it would be incorrect to perceive Nurse Skeptical as having made a decision -- consciously or otherwise -- to eliminate Mrs. Testy's autonomy in the provision of her own care, but rather she would be seen as a psychological being herself, reacting to the psychological and interpersonal pressures of her job. Although this view holds some merit, however, it would require a great deal more detail and investigation before it could be put forward as a likely alternative explanation for the perceived professional-client relationship in this scenario, and indeed in any other similar real-world setting of medical practice.
Conclusion
The issue of the professional-client relationship ultimately comes down to a question of responsibility. Nurse Skeptical, as the apparent primary care provider for Mrs. Testy, is essentially responsible for providing the patient with medical care. Part of being an autonomous human being, however, is the privilege (and the burden) of being responsible for oneself. Nurse Skeptical's decision in this hypothetical scenario eliminates Mrs. t=Testy's responsibility for her own care without any sort of discussion -- let alone consent -- on Mrs. Testy's part. This is the reason that the parental professional-client relationship should be avoided.
References
Andre, J. (1994). "My client, my enemy." Professional Ethics 3(3/4), pp. 27-46.
