Enemies of Patients

Clinton's health system reform team would do well to read this study by Macklin, professor of bioethics at New York City's Albert Einstein College of Medicine--for Macklin seeks to disentangle the increasingly complicated, even adversarial relations between the medical establishment and its patients. Her account is detailed and persuasive. Although doctors appear to focus on the medical interests of patients, the author explains, doctors are often accused of being their patients' ``enemies'' by patient advocate groups. Further, there are other culpable forces intruding on patients' well-being, such as insurance companies and hospital management. Macklin points out that the 1973 12-point Bill of Patient Rights and the 1991 Patient Self-Determination Act helped to establish patient participation in the decision-making process, as stipulated in patients' legally binding ``advance directives''--such as Living Wills and surrogate mothers. To forestall malpractice or negligence suits, hospitals have responded by hiring ``risk managers'' to monitor and to act as liaison agents between all parties, including families. Macklin's book could steer reformers in the right direction. (May)