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Wish-fulfilling medicine in practice: a qualitative study of physician arguments
  1. Eva C A Asscher1,
  2. Ineke Bolt1,2,
  3. Maartje Schermer1
  1. 1ErasmusMC, Department of Medical Ethics and Philosophy of Medicine, Rotterdam, The Netherlands
  2. 2Ethics Institute, Department of Philosophy, Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Dr Eva C A Asscher, ErasmusMC, Department of Medical Ethics and Philosophy of Medicine, Dr Molewaterplein 50, Postbus 2040, Rotterdam 3000CA, The Netherlands; e.asscher{at}erasmusmc.nl

Abstract

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’.

  • Biomedical enhancement
  • medical ethics
  • plastic surgery
  • general practitioners
  • qualitative research
  • clinical ethics
  • concept of health
  • enhancement
  • general medicine/internal medicine
  • informed consent
  • telecare
  • quality of life
  • pragmatism
  • good life
  • geriatric care
  • dementia
  • neuroethics
  • patient autonomy
  • competence

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Footnotes

  • Funding ZonMw (The Netherlands Organisation for Health Research and Development), grant number 141010006.

  • Competing interests None.

  • Ethics approval This is not necessary under Dutch law for interview studies with competent adult physicians.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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