The Physician as Captain of the Ship

1. Front Matter

   Pages i-xv

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2. The Captain’s Authority: Sources and Scope

   1. Front Matter

      Pages 1-1

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   2. The Physician and Authority: A Historical Appraisal

      • Russell C. Maulitz

      Pages 3-21

   3. Narrow Passageways: Nurses and Physicians in Conflict and Concert Since 1875

      • Joan E. Lynaugh

      Pages 23-37

   4. Legal Intrusions on Physician Independence

      • Judith Areen

      Pages 39-65

   5. The Authority of the Captain: Reflections on a Nautical Theme

      • H. Tristram Engelhardt Jr.

      Pages 67-73

3. Sharing the Captaincy

   1. Front Matter

      Pages 75-75

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   2. Team Medicine in The NICU: Ship or Flotilla of Lifeboats?

      • Ernest N. Kraybill

      Pages 77-88

   3. “Ship? What Ship? I Thought I was Going to the Doctor!”: Patient-Centered Perspectives on the Health Care Team

      • David Barnard

      Pages 89-111

   4. Who Chartered This Ship?

      • Peter J. Morris

      Pages 113-122

4. Technology and Financing: Changing the Course

   1. Front Matter

      Pages 123-123

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   2. The Physician And Technological Change

      • Robert M. Cook-Deegan

      Pages 125-158

   3. Marketing Health Care: Ethical Challenge to Physicians

      • Stuart F. Spicker

      Pages 159-176

   4. Social Goals and Doctors’ Roles: Commentary on the Essays of Robert M. Cook-Deegan and Stuart F. Spicker

      • Wendy K. Mariner

      Pages 177-187

5. Captains, Committees, and Communities

   1. Front Matter

      Pages 189-189

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   2. Unshared and Shared Decision Making: Reflections on Helplessness and Healing

      • Raymond S. Duff

      Pages 191-221

   3. Ethics Committees: Talking the Captain Through Troubled Waters

      • Nancy M. P. King

      Pages 223-241

6. Back Matter

   Pages 243-256

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"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically.

• clinic
• ethics
• health
• health care
• morality

• University of North Carolina School of Medicine, Chapel Hill, USA

  Nancy M. P. King, Larry R. Churchill, Alan W. Cross

Policies and ethics