Doctor-patient relationship in oncology: how to prevent and solve some conflicts?

Abstract

The inequality between doctor(s) and patient(s) is a frequent cause of ethical and relational difficulties. To know the elements of this inequality is a requirement to improve their relationship. The major elements of this inequality: the patient experiments suffering and may die; the doctor belongs to a group, has a wide knowledge, the ability to cure, is active. Some elements diminish this inequality: patients associations; new laws (the right to be informed, to give one's informed consent, to have free access to one's medical file, to refuse the treatment, etc.); relinquishing paternalism and making shared decision; improving doctor's competence in information. Equality also means solidarity and reciprocal knowledge, respect and trust. Specific objectives have to be acknowledged: the patient's and the doctor's ones can be different. Patients and doctors should have an equal exigency of rights and duties: they cannot do or demand anything. Both of them need to be recognized as competent in their own tasks, and responsible towards each other, the other patients, themselves. They equally require to preserve one's ideals, to keep one's identity, one's sense of dignity and value. Equal freedom to think and act can be hindered by the influence of others, but also by inadequate emotions, fantasies, unconscious thoughts and memories. The psycho-oncologists and the psychoanalytic experience are therefore useful to overcome these unconscious obstacles. Medical staff should also have the experience of solving the ethical difficulties that inequality can raise.