Nursing ethics and the parental professional-client relationship

Professional Client

Development and Analysis of a Nursing Professional-Client Relationship: A Hypothetical Case Study

Professional-client relationships can be governed by a multitude of forces and attitudes on the part of both the medical practitioner and the patient, as well as organizational and familial pressures in a somewhat less direct but still quite profound manner. The relationships between a patient and their medical care providers can also be hugely important in determining the efficacy of the care provided and the quality of life for the patient (and indeed for the medical practitioner) during treatment. There are several different major types of professional-client relationships that have been identified, and this paper will examine a hypothetical scenario in order to illuminate a primary relationship and a conflicting interpretation.

In the scenario, Nurse Skeptical suspects that the ongoing pain reported by her patient Mrs. testy is psychologically-based rather than a physiological symptom of her condition, and has thus recommended -- and received approval for -- a placebo trial. Nurse Skeptical has decided to replace the medication for pain that Mrs. Testy reports with placebos for two weeks, knowing that if Mrs. Testy reports the same reduction in pain based on her ingestion of the placebos that the pain is indeed psychological rather than a physical symptom. Nurse Skeptical's decision reflects a parental approach to the professional-client relationship, where the practitioner carries a "moral authority" over the entirely dependent patient (textbook, pp. 126). Though this stance is not entirely without its value and could be seen as defensible in some ways, it is essentially an inappropriate relationship.

The Parental Professional

When patients still possess their autonomy -- i.e. they are not children or adolescents, nor do they have any mental problem that would prevent them from making decisions in their own interest or a physical problem limiting form the expression of the desires -- it has long been considered a necessity to have these patients involved in their care and the decisions thereof through informed consent, which can help prevent patients from feeling wronged or like "the enemy" (textbook, pp. 126; Andre 1994, pp. 27). There are several healthy professional-client relationships that take this notion of consent and partnership into account when making medical decisions, ensuring that both the medical professional and the client being provided with medical care understand and agree with the methods of care beings discussed and agreed to before any change in care takes place.

The parental professional-client relationship is not among these, however. By definition, the parental relationship -- in the literal scenario of a parent and their child and in the more figurative application of the term to a medical professional and their patient -- is built on the notion that one party (the child or patient) has no autonomy, but rather falls completely under the power of the other party (the parent or medical professional) (textbook, pp. 132). The notion of informed consent is entirely set aside as an unnecessary facet of the provision of medical care; it is assumed that the medical professional knows best and will act with the best interest of the patient at heart, without any need to consult with them or even to necessarily explain treatment options and courses to them.

The scenario at hand quite clearly fits into this explanation of the parental professional-client relationship. Nurse Skeptical has come to a determination regarding Mrs. Testy's care that specifically and explicitly involves removing Mrs. Testy from any communications regarding changes to her treatment plan (at least insofar as the issue of pain medication is concerned), placing all control in the hands of Nurse Skeptical and her advising physician. Nurse Skeptical's belief that Mrs. Testy's pain is psychologically rooted and entirely non-existent as a physiological symptom implies a belief on Nurse Skeptical's part that Mrs. testy is not even fully capable of rendering an account of the progression and symptomology of her condition, further reducing any remnant of autonomy the patient has left in Nurse Skeptical's mind and eliminating any possibility of informed consent being made available.

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 always) possess a desire to learn at all stages in their career, and the inability for Nurse Skeptical to mitigate and/or understand Mrs. 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.