Indeed, by an active participation of the patient, we also tacitly understand that the patient is also fully informed about the course of the medical treatment, about his condition and even about the way scientific research affects his or her illness.
On the other hand, this model has several important setbacks. First of all, it is a matter of time and usually a physician is involved with more than one patient. The deliberative model, because of its customization and patient involvement, would require a physician to be ready to give up as much time as possible for one single patient, in order to best inform him, but also to ensure that all matters of interest to the patient are discussed and referred to. A physician would almost never have this much time for one single patient.
Second, the additional time required with such a model obviously requires additional costs as well, with extra hours for the physicians and a lower, overall productivity, if that is considered to the level of all patients under that physician's care. In a medical care unit, following the deliberative model, you would need more physicians to attend to all the patients and potentially an additional number of medical instruments to complement that.
Third, it is also a matter of physician education and usually medical education targets the physician theoretical and practical background in all health related areas rather than things such as communication. Communication is not only a skill, it is also a science and many physicians are simply too applied to medical care to have much knowledge of the science of communication. Following this course, it will probably take more time and additional costs to train physicians able to fit into the deliberative model.
3. There are several arguments that Engelhardt provides in his explanation why the U.S. government has no moral obligation to provide health care for each of its citizens. The first is that if there was a universal health care system, this would be provided by the governed who pay for it (the governed contribute to the budget of the U.S. government, which would be partially spent on universal healthcare) and the fact that someone else would be paying for the health care would encourage individuals to a more reckless behavior than if they were paying for the health care themselves.
The second argument would state that an individual would need to have specific background on the issue in order to be able to solve a moral controversy, something which, in the case of health care, only a small amount of the population actually does have.
I think that the most important ethical reason against Engelhardt's arguments resides in the fact that this type of argument could perhaps be applied to all other areas in which the U.S. government needs to invest on behalf of its population, according to its duties. This would include education or social services, for example. Engelhardt could argue that universal education is not a moral obligation for the state, which would definitely limit the capacity of the state itself to develop in the future.
According to an unwritten contract between the state/government and its citizens, the U.S. government has some basics services that it needs to offer to its citizens and this includes both health care and education. Making a difference in the offer of universal health care would mean that you are able to discriminate between individuals who may or may not receive it.
I think the most important argument that the President's Commission could provide for Engelhardt is termed with "respect for persons." Not providing universal health care is exactly a show of disrespect for persons and, if we follow further on the path of the necessary discrimination that this involves, this increases disrespect for persons under the jurisdiction of the U.S. government. The money that individuals pay for the U.S. budget in the form of various taxes has to return to them somehow.
1. Mary Elizabeth; O'Brien, Thomas Gordon; W. Sterling Edwards. Making the patient your partner. Greenwood Publishing Group. 1995
Mary Elizabeth; O'Brien, Thomas Gordon; W. Sterling Edwards. Making the patient your partner. Greenwood Publishing Group. 1995