FOUR MODELS OF THE HEALTH PROFESSIONAL- PATIENT/CLIENT RELATIONSHIP Paternalistic Informative Interpretive Deliberative

PATERNALISTIC MODEL (Priestly, Parental) Selected information provided that will encourage patient/client to consent to intervention health professional considers best. At extreme, health professional tells patient/client when intervention will be initiated. Acts as patient/client guardian. Conception of patient/client’s autonomy is assent to health professional’s determination of what best. Health professional’s FACTS and VALUES.

INFORMATIVE MODEL (Scientific, Engineering, Consumer) Objective of interaction is for health professional to provide patient/client with all relevant information; for patient/client to select interventions he or she wants and health professional to execute intervention. Assumes clear distinction between facts and values. Patient’s values are known but lack facts. Health professional provides facts, and patient/client’s values determine the treatments to be given. There is no role for health professional’s values. Health professional is purveyor of technical expertise. Conception of patient/client autonomy is patient control over decision making. Health professional’s FACTS and patient/client’s VALUES.

INTERPRETIVE MODEL Aim of health professional – patient/client interaction is to elucidate the patient/client’s values and to help the patient/client select the available interventions that realize these values. While providing information, the health professional also assists the patient/client in elucidating and articulating values. Model assumes patient/client’s values are not necessarily fixed or known. Health professional does not dictate; it is the patient/client who ultimately decides which values an course of action best fit. Health professional as counselor; engaging patient/client in joint process of understanding. Conception of patient/client autonomy is self- understanding. Health professional’s FACTS and patient/client’s VALUES as elucidated/interpreted/understood by the health professional.

DELIBERATIVE MODEL Aim is to help patient/client determine and chose best health-related values that can be realized in the clinical situation. Delineates relevant information on the patient/client’s situation and helps elucidate types of values embodied in available options. Health professional suggests why certain health related values are more worthy and should be aspired to. Health professionals actions are no more than persuasive -- coercion is avoided. Health professional as teacher (doctor) or friend. Conception of patient/client autonomy is moral self-development; patient empowered to consider, through dialogue, alternative health-related values, their worthiness, and their implications for treatment. Health professional’s FACTS and VALUES, and patient/client’s VALUES