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The Care of a Good Caregiver: Legal and Ethical Reflections on the Good Healthcare Professional

Published online by Cambridge University Press:  29 July 2009

Wibren van der Burg ,
Pieter Ippel ,
Alex Huibers ,
Babette de Kanter-Loven ,
Ina Smalbraak-Schieven  and
Laurens van Veenendaal
Wibren van der Burg
Affiliation:
The leader of the Ethics and Law project at the Center for Bioethics and Health Law, Utrecht University, The Netherlands, and is a senior research fellow in the Department of Philosophy
Pieter Ippel
Affiliation:
An advisor for the Center for Bioethics and Health Law, Utrecht University, The Netherlands, and is head of the department at the Date Protection Office, The Hague
Alex Huibers
Affiliation:
A manager of the Center for Bioethics and Health Law, Utrecht University, The Netherlands
Babette de Kanter-Loven
Affiliation:
A research fellow at the Center for Bioethics and Health Law, Utrecht University, The Netherlands
Ina Smalbraak-Schieven
Affiliation:
An advisor for the Center for Bioethics and Health Law, Utrecht University, The Netherlands
Laurens van Veenendaal
Affiliation:
Participates in the Center for Bioethics and Health Law, Utrecht University, The Netherlands, and is coordinator of the Rudolf Magnus Graduate School on Experimental and Clinical Neurosciences
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Extract

A central concept in Dutch health law is the care of a good caregiver (de zorg van een goed hulpverlener). We find this standard in various (proposed) statutes and in legal doctrine. This concept is, however, vague and open and must be made more concrete in professional practice, in moral theory, and in law. In this article, we explore the implications of this complex standard and analyze what moral philosophy and jurisprudence can contribute to its clarification and implementation in professional practice and law. We start with some reflections on how practitioners see this norm and try to live up to it.

Type
Special Section: Healthcare Relationships: Ties that Bind
Information
Cambridge Quarterly of Healthcare Ethics , Volume 3 , Issue 1 , Winter 1994 , pp. 38 - 48
Copyright
Copyright © Cambridge University Press 1994

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References

Notes

1. The word caregiver in Dutch law includes most of the medical and paramedical professions, such as physicians, nurses, dentists, physical, and psychical therapists.

2. It was one of the seven seminars and conferences that were organized in 1992 to celebrate the fifth anniversary of the Center for Bioethics and Health Law at Utrecht. The papers of these seminars were published in Brom, FWA, van den Bergh, BJ, Huibers, AK, eds. Ethiek en Beleid. Assen, The Netherlands: Van Gorcum, 1993. This article builds on our own paper in this book.Google Scholar

3. These three professionals, M. Bakker-Winnubst, A. P. M. Heintz, and R. H. Oudkerk, presented a paper at the seminar as well. See note 2. Brom, et al. 1993.Google Scholar

4. Respectively, goed patiëntschap, goed zorgverzekeraarschap, and goed gezondheidszorgschap. See note 2. Oudkerk in Brom, et al. 1993.Google Scholar

5. Here, as elsewhere in this article, we talk about the Dutch situation as we perceive it. How this sketch is of more general value for other countries as well falls outside the scope of this article.

6. See van der Burg, W. Het Democratisch Perspectief. Arnhem, The Netherlands: Gouda Quint, 1991, for a defense of this methodological pluralism.Google Scholar

7. Beauchamp, TL, Childress, JRPrinciples of Biomedical Ethics. New York: Oxford University Press, 1989;Google ScholarPubMedPellegrino, ED, Thomasma, DC. For the Patient–s Good. New York: Oxford University Press, 1988.Google Scholar

8. Kuitert, HM. Een goede dokter. Medische ethiek als ethiek van een beroepsgroep. In: Mag Alles Wat Kan? Ethiek en Medisch Handelen. Baarn, The Netherlands: Ten Have, 1989:63–76.Google Scholar

9. Of course, almost no author only focuses on one element. Thus Pellegrino and Thomasma grounded their virtue ethics in the physician-patient doctor relationship and did not completely deny the importance of rules and rights. Nevertheless, we may discern clear differences in emphasis.

10. See Fuller, LL. The Morality of Law. New Haven, Connecticut: Yale University Press, 1978Google Scholar. This distinction is also central to Selznick, P. The Moral Commonwealth. Berkeley: University of California Press, 1992.Google Scholar

11. An interesting defense for the rationality of striving for ideals even if they are impossible to attain may be found in Rescher, N. Ethical Idealism. Berkeley: University of California Press, 1987:135.Google Scholar

12. Philip Selznick argued that we need a balanced view of moral idealism and moral realism and therefore need combine a baseline morality with a morality of aspirations: “In the theory of moral ordering … we should identify both what we can aspire to and what we must guard against.” See note 10. Selznick, . 1992:146.Google Scholar

13. The degree to which law is only a background ordering may vary. Law seems to be much more in the foreground in the United States than in The Netherlands.

14. In this context, we cannot deal with all the grounds and reasons for a domain of professional autonomy and professional responsibility. However, acknowledging such a domain may do justice to the complex structure of care provision.

15. See note 10. Selznick, . 1992:260. “A morality of aspiration is not easily captured or readily cabined by rules and systems.”Google Scholar

16. Thus one might say, in the words of Ronald Dworkin, that though law is not a seamless web, it must be regarded as if it were a seamless web. In a sense, the gaps are thus illusory.

17. An interesting analysis of the “prelegalized” (voorgejuridiseerde) structure of the Dutch debate on organ transplants may be found in Trappenburg, MJ. Het recht van definitie: over de structuur van medisch-ethische debatten. In: Witteveen, WJ, Stout, HD, Trappenburg, MJ, eds. Het Bereik van de Wet. Zwolle, The Netherlands: W. E. J. Tjeenk Willink, 1992:141–58.Google Scholar

18. The rise of defensive medicine in the United States and increasingly in other countries forms an example.

19. This risk has been noticed in Wéldoen of Niet-doen. Zorgvuldig Handelen bij Toepassing van Dwang en Drang in de Ggz. Zoetermeer, The Netherlands: NRV (National Council for Public Health), 1992.Google Scholar

20. In this distinction, we build on previous work: Nonet, D, Selznick, P. Law and Society in Transition: Toward Responsive Law. New York: Harper & Row, 1978Google Scholar. Peters, AAG. Law as critical discussion. In: Teubner, G, ed. Dilemmas of Law in the Welfare State. Berlin: De Gruyter, 1986:250–79.Google Scholar

21. The distinction of digital and analogous stems from Schuyt, CJM. Tussen Macht en Moraal. Over de Plaats van het Recht in Verzorgingsstaat en Democratie. Alphen aan den Rijn, The Netherlands: Samsom, 1983.Google Scholar

22. This interactive model of law is inspired by the work of Jürgen Teubner. His ideas of reflexive law have Influenced the Dutch Department of Justice, especially in the important official report Zicht op Wetgeving.