Positive Relationships Essay

Positive Relationships Essay.

According to Steven frost, the energy of relationships can make a huge difference to the feelings of an individual. In the effort to surround yourself with and create positive relationships, the beneficial qualities of taking part in a relationship which identifies as positive can bring wonders to any individual. In my opinion there are several qualities and attributes which contribute to building a positive relationship with others and they will be detailed throughout the remainder of this paper.

Throughout my development of this topic, I have identified the main qualities which I believe build and form the foundations of a positive relationship.

These include: positivity, perception, honesty, understanding and mutual respect. I also believe that realistic expectations are vital to development of any relationship; whether it be between partners, friends or family.

Spending time to give compliments, commend ideas, acknowledge achievements and appreciate others forms the epitome of positivity. Positivity in all its forms lightens and takes relationships to the next level.

As is evident from the movie Juno, the positivity throughout Juno and Pauly’s relationship turns a potentially disastrous situation into a simple, uncomplicated pregnancy. Even in modern day society, positivity vastly contributes to the development of any positive relationship.

Perception and understanding, relatable in their qualities, distinctly relate to this topic. In our constantly busy world, the art of true listening, understanding and perceiving is a rare but simple gift. Others often forget to stop and really listen to those important to them. I believe that being a good listener and being there for each other has the power to truly transform not only others’ lives but our own. Throughout the bible, Jesus reiterates these qualities and the power of listening is very powerful both in the ancient and modern eras.

The example of prominent figures in the Catholic faith like Catherine McAuley and Mother Theresa provide a constant framework for building positive relationships thanks to the powerful influence they exert on the populace. Having a positive relationship with your beliefs is also a major component of religion and again the components mentioned above apply to these situations. A positive relationship must reflect your values and beliefs as well as a sense of perception to what the individual at the receiving end is feeling. Faith and religion play a vital role in developing the foundations of a positive relationship, many of the stories in the bible and teachings centre around kindness towards each another and I personally believe this is a major part of not only developing one, but being part of a relationship that is beneficial to both sides.

The catholic religion is a religion that over time provides us with many pertinent qualities that contribute towards the development of positive relationships. Whilst my time at Catholic school- Mercedes College is almost coming to an end, the values and attitudes I have learnt from the teachings of the Christian faith have really put into perspective the role one plays in order to be a part of a positive relationship. The whole concept of religion to me means being part of a community or ‘relationship’ that requires constant devotion and the ability to constantly maintain that relationship, even throughout times of hardship. This is the main reason why I believe the whole concept of faith is distinctly related to relationships between individuals and the ability to maintain that relationship is a great skill indeed.

Building a positive relationship takes time and a great deal of hard work. With the concepts mentioned above, relationships can mean anything from individuals to a certain faith however the main attitudes and values are prevalent in all. Indeed, building a positive relationship takes time, but who’s’ to say its not worth it?

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Positive Relationships Essay

The representation of a Mother and Son relationship Essay

The representation of a Mother and Son relationship Essay.

Chang-Rae Lee’s story, Coming Home Again, is a powerful story about the author’s relationship with his mother.

The story is told from the author’s point of view. Lee begins the story in the present when his mother is terminally ill from stomach cancer and then quickly flashes back to the time before he left to attend Exeter boarding school far away from home. Growing up as a young child, he shares a very close relationship with his mother. His mother teaches him everything from cooking to playing basketball.

Cooking, in particular, symbolizes the close relationship between the author and his mother because it is one activity Chang-Ray grew to enjoy over the years of watching and learning from his mother. Their common love for cooking is instrumental in keeping their relationship close, despite the times they felt emotionally distant from each other. The loneliness Chang-Rae feels at boarding school, away from his mother, strengthens the bond between him and his mother.

He realizes that living apart from his mother and her delicious meals is much more difficult than he thought, and so his returning home signifies his enduring love for her and longing to spend all of his time with her. This essay will examine how cooking and distance are instrumental in keeping Chang-Rae Lee and his mother close together. Topic Sentence #1: Cooking The aroma and mouth watering taste of his mother’s meals inspired Chang-Rae Lee to learn how to cook at a very young age. -As a young child Chang-Rae Lee would watch his mother cook traditional Korean meals, and learn how to cook American meals.

At times, he would enter the kitchen, and insist on helping her cook the dinner meals, when she did not need help. His desire to learn to cook the way his mother cooks enables the mother and son to form a close relationship. -Food is instrumental in keeping the mother and son close together, even when Chang-Rae Lee is far away at school. Her cooking is a constant reminder of her love for him. It is also her way of showing him how much she misses him and how much she wishes he was back at home. -By the time he graduates from high school, his mother is dying from stomach cancer.

It is now up to him to take care of her. He cooks her the same meals she cooked for the family and struggles to make the food as good as she did. His cooking is a token of appreciation for everything his mother did for him. Topic Sentence #2: Distance When Chang-Rae Lee leaves home for the first time to attend a boarding school far away, he does not realize how much he will miss his mother until he is at school. -Before he leaves for school, Chang-Lee, like every teenage boy, seeks to establish a life outside his family, and one that does not include his family.

He gets extremely frustrated when his mother constantly wants him to do favours for him and even argues with her. -The large distance between Chang-Rae and his mother actually creates a stronger bond between the mother and son. Chang-Lee finds himself missing his mother and her cooking and always relishes his time with her and his father when they make trips to visit him at his school. When he returns home after graduating from high school, he enjoys spending time with his mother, especially since he knows he does not have her for too much longer.

The representation of a Mother and Son relationship Essay

Parental Involvement And Its Relationship To Discipline In Elementary Schools Essay

Parental Involvement And Its Relationship To Discipline In Elementary Schools Essay.

There is a plethora of research on books, journal articles, and stand-alone reports on the subject of parental involvement and its relationship to discipline in schools. These writings include research reports, expert opinions, theory papers, program descriptions, and guidelines for how to address this issue. Many of these reports are informative and useful, and because parental involvement and its link to discipline have been greatly emphasized in the past few years, there is considerable current information.

An important influence on the way parents raise their children are the experiences they have in their family of origin (Hops, Davis, Leve, & Sheeber, 2003).

The way a person is raised influences the rest of their life. Socioeconomic status can have a very significant effect on a family and how parents behave with their children. This effect continues into the school environment and could be directly related to how students behave in schools (Hops et al. ). The extra stress that families from a lower Socio Economic Status (SES) household experience can cause parents to use more punitive parenting practices.

Some students have shown that, along with the economic hardships families from low SES groups experience, minority ethnic groups also have to deal with the added stress of racism (Pinderhuges, Dodge, Bates, Pettit, & Zelli, 2000). These factors all have an influence on parental involvement and its relationship to discipline in schools. Discipline concerns in schools are not new. MacDonald (2002) stated that student behaviors that require discipline have always existed in schools. However, it is the seriousness and widespread nature of discipline concerns that is disturbing.

School campuses, once islands of safety, are now faced with violence daily (MacDonald). School discipline problems are impacting every demographic segment of society. O’Donoghue (2005) stated that in the 1990s, discipline concerns were viewed widely as an inner city phenomenon, but since then, discipline concerns have been distributed across the entire spectrum of schools in the United States of America. At a time when our nation’s children need adult guidance the most, some parents retreat from involvement in their child’s schools.

Johnson (1999) stated that our nation’s youths are making desperately poor choices oftentimes guided by equally confused peers. All children, youths, adolescents, and teenagers alike need the advocacy and support of parents. Parental involvement is vital to the behavior and achievement of students. Unfortunately, many parents are doing much less than they should be doing. According to the U. S. Department of Education (2005), American mothers, on the average, spend less than half an hour a day talking, explaining, or reading with their children, and fathers spend less than 15 minutes interacting with their children.

As vital as parental involvement is to discipline in schools, many parents do much less than they should and many schools engage in practices which serve to limit the extent of parental involvement. Literature Review Several researchers have attempted to categorize parental involvement according to the nature or type of activity in which parents are involved. Epstein and Salinas (2004) suggested that parents may be involved as tutors, volunteers, advisory committee members, school board members, or room mothers or room fathers.

They grouped these types into three basic groups: advocates, decision-making partners, and co-production partners. They defined advocacy as politically active parental involvement; decision-making refers to parental involvement as committee members; and co-production refers to parental involvement in those areas or activities that contribute to school efforts for developing and planning and instructing students toward improved behavior and achievement (Epstein & Salinas).

Data from the 2005 Children’s Defense Fund indicated that every day in American, 13,076 students are suspended from school, 6,042 students are arrested, 3,356 high school students drop out of school, and 3,087 students are corporally punished. Additionally, more than 3 million acts of violence and theft were reported in American public schools (Walker, Colvin, & Ramsey, 2005). A factor in improving discipline in American schools is to empower school personnel to be proactive rather than reactive.

This means that teachers must become skilled in behavior management strategies that would enable them to create school environments that motivate students to act according to school and classroom rules as well as foster positive interpersonal interactions with peers and authority figures (Lewis & Sugai, 1999). In contrast to zero tolerance policies that emphasize punishing instead of positive consequences, it is critical to stress positive incentives that will motivate all students to behave (Lewis & Sugai).

When schools develop disciplinary action plans, parents should be included at every stage of the process to obtain their input and to give them a sense of shared responsibility. According to the National Parent Teacher Association (2004), the following three types of parental involvement are critical to a child’s education: (a) parents as first educators in the home; (b) parents as partners with the school; and (c) parents as advocates for children in society.

The full involvement of parents is vital to the success of these efforts. Barton, Coley, and Wenglinsky (1998) identified four basic components of parental involvement: the basic obligation of parents, school to home communications which include monitoring students’ discipline, parental involvement at school, and parental involvement in learning activities at home. Children growing up in society today need parental involvement and adult attention more than ever before (Comer, 2006).

Parents belong at the center of a child’s education. The single best way to improve students’ behavior is by strengthening parents’ role in it, by both reinforcing parents’ relationships with the school and by helping and encouraging parents in their critical job of teaching the young. Not all teachers are parents, but all parents are teachers (Comer). The most basic statement that can be made about parent and family involvement is that when it is effective, everyone benefits.

Research has shown us conclusively that effective parental involvement in education benefits parents, teachers, and students, whether the involvement is at the pre-school, elementary, middle, or high school level (State Department of Iowa, 1999). Purpose of the Study The purpose of this study was to examine issues surrounding parental involvement in schools. The experiences of parents were examined with the goal of giving parents an opportunity to express themselves in parent surveys.

The study brought new insights to the body of research concerning parental involvement and its relationship to discipline in schools. Research Questions 1. What is the relationship between the level of parental involvement and the number of student discipline referrals? 2. What is the relationship between socio economic status and the level of parental involvement? 3. What is the relationship between the level of parental involvement and student academic success? Limitations/Delimitations Limitations 1.

This study was limited to two elementary schools in a Trenton, North Carolina school district. 2. One limitation would be the honesty of parents’ responses. 3. Another limitation would be the sample size of the respondents; therefore, the findings should be viewed with caution. Delimitations 1. Duplication of the study may or may not produce the same results. 2. The study analyzed one school year of discipline records for students. Definition of Terms Parental Involvement – Parents’ level of active involvement in their child’s education (Epstein & Salinas, 2004).

Parenting Styles – What strategies parents use to as it relates to disciplining their children at home (Coolahan, McWayn, Fantuzzo, & Grim, 2002). Socioeconomic Status – A person’s social and economic status (Bradley & Corwyn, 2002). Student Academic Success – measured by students’ mathematics and reading scores obtained from the Georgia Criterion-Referenced Competency Tests (GCRCT). Student Discipline – Control or order exercised over students. The system of rules used to maintain this control (Barton, Coley, & Wenglinsky, 1998).

Student Referrals – Discipline referrals students receive for disciplinary problems in school (Gosche, 2005). Importance of the Study It has become increasingly evident that parental involvement in education contributes to students’ success in school. Research also suggests that when parents are involved in their children’s learning at school and at home, discipline referrals decrease at school and academic progress increases (Comer, 2006). This study is important because it investigated the relationship between the level of parental involvement and student academic success.

It also investigated the relationship between the level of parental involvement and the number of student discipline referrals and the relationship between socio economic status and the level of parental involvement. It is essential for this data to be examined because the results will assist school boards, statewide evaluators, and school personnel in restructuring the learning environment to address and include parental involvement and its relationship to discipline in schools. Chapter Two will provide a review of the literature findings on parental involvement and discipline.

CHAPTER TWO: REVIEW OF THE LITERATURE Introduction Not all parents are involved in their children’s school although there is a dire need for parental involvement and guidance in schools (Kornbluth, 1997). All children, regardless of age, need the unwavering support of their parents to further guide their academic growth. According to the U. S. Department of Education (2005), “American mothers, on the average, spend less than half an hour a day talking, explaining, or reading with their children, and fathers spend less than 15 minutes daily interacting with their children” (p.

2). The U. S. Department of Education further stated that positive results such as increased student performance, better communication between parents and teachers, and better socialization skills occurred when parents play an active role in their children’s education. According to Barton, Coley, and Wenglinsky (1998), chaos in the schoolhouse requires disciplinary measures. An exemplary discipline program is truly vital to the success of schools, thus making good discipline an educational requirement.

Research has shown that when schools have discipline problems, academic achievement is negatively affected. As a result, a distinct relationship exists between how students achieve academically and their behavior in school (Barton, et al. ). A dire need exists for parents to partner and communicate with school staff so that problems with discipline could be reduced. Johnson (1999) stated that poor choices are often made by children and adolescents in the United States, and these choices are oftentimes aided by their bemused peers.

Research by Kornbluth (2006) has noted that many schools do not put forth enough effort to enlist parents’ support and involvement in schools. On the other hand, Waggoner and Griffith’s (2001) research revealed that students with involved parents performed at higher levels on standardized tests than students with uninvolved parents. In a similar vein, Kornbluth’s study found that students not only performed better in school but also improved in discipline when their parents were actively involved in their education.

It has become increasingly evident that parental involvement in education is a major contributing factor to reduced disciplinary concerns and a need for disciplinary action in schools. An article by the San Diego County Office of Education (2000) entitled, What Does Research Tell us About the Influence of Parental Involvement on Student Achievement, includes research on the benefits of parents nurturing their children at home and the importance of parents setting academic goals and expectations for their children. It also stresses the importance of parents’ involvement in their children’s education as it relates to their academic success.

According to Parlardy (2005), parental involvement produces a decline in classroom disruptions and the need for disciplinary action while improving school climate, teacher and student morale, and student achievement. Cotton’s (2001) study revealed the importance of effective schoolwide and classroom discipline strategies and lists various ways to improve discipline in schools such as staff commitment to achievement, parental involvement, high expectations for students and faculty, clearly defined rules, and good school climate.

Additionally, Wright, Wright, and Heath (2004) provided research on how the No child Left Behind act affects parents, teachers, administrators, and students as it relates to discipline and parental involvement. Waggoner and Griffith’s (2001) research supported parental involvement since it strengthens teacher/parent/student relationships and reinforces teachers’ expectations in the home environment. Homework is another area where parental involvement is critical.

When parents are aware of what the curriculum entails and what teachers expect, they are better equipped to help their children with homework so that increased learning could occur. Kornbluth (2006) provided data to support the importance of parental involvement in schools. The results of their study revealed that students with involved parents performed better on tests than students with uninvolved parents. Hand in hand with parental involvement is involving the community in the school. Epstein and Salinas (2004) noted the benefits of partnering with the community.

These benefits included having businesses become partners in education and serving on school councils along with parents. The benefit that is derived from this is that the community is involved in the decision-making process of the school and; therefore, has a pulse for the school’s goals and missions. As a result, one of the goals will also be to decrease disciplinary infractions and improve student learning. What is Parental Involvement? There are numerous books, journal articles, and stand-alone reports on the subject of parents’ involvement in their children’s education.

Parental involvement is a term that frequently has different meanings to people. Nevertheless, it is safe to say that parental involvement covers a multitude of interactions between parents, students, and the school (Swap, 1998). Swap further postulated that parental involvement may be as simple as a parent attending a Parent Teacher Association (PTA) meeting or a conference with the teacher or as complex as representing other parents in decision-making situations or other aspects of school governance.

In general, parents may take an active role, passive role, or non-involvement role regarding their participation in the school their child attends. A review of literature indicates that there are several strategies and activities available to parents, teachers, and administrators to obtain optimum parental involvement at different levels of commitment. For example, parents may volunteer to read to a class, become a book buddy for a student, or work with their child on take-home learning materials (Gordon, 1998).

The research overwhelmingly demonstrates that parental involvement is a component that is positively related to improving students’ discipline and achievement in schools. When defining parental involvement, it is very important to consider Brandt’s (1979) four basic assumptions about parental involvement. The first assumption is that the family’s capabilities for providing a learning environment that accentuates the positive elements of cognitive and emotional factors can be improved (parent impact model).

The second assumption is that the child’s health, nutrition, social, and psychological development influences academic learning (comprehensive services model). The third assumption is that when schools are made more responsive to parents, this responsiveness will lead to better discipline and achievement by the child (school impact model). The fourth assumption for parental involvement is that everything relates to everything else (community impact model). Swap (1998) asserted that various models have different assumptions and goals that must be clear to all participants.

Swap’s premise of parental involvement described four models and their goals: The protective model’s goal is to reduce conflict between parents and educators, primarily through the separation of parents’ and educators’ functions and to protect the school from interference by parents. The second model’s goal (school to home transmission) is to enlist parents in supporting the objectives of the school. The third model’s goal (curriculum enrichment) is to expand and extent the school’s curriculum by incorporating the contributions of families.

Finally, the fourth model’s goal (partnership) is for parents and educators to work together to accomplish a common mission – success for all children. Barriers to Effective Parental Involvement According to Hampton, Mumford, and Bond (1998), many students come from home environments described as America’s worst problems such as drug abuse, neglect, alcoholism, and domestic violence. On the other hand, Kornbluth (1997) maintained that not all students are in trouble because their parents are irresponsible, lazy, or uninvolved.

Many students come from good homes, and they have parents who are doing their best to care for them. Often parents face different circumstances that affect how well they believe they can make contributions to their children’s education. Issues such as language barriers, work schedules, transportation, and access to childcare, for example, affect the frequency and conditions under which parents believe they can realistically spend time in schools (Kornbluth).

Seeley (1999) noted that another complicating factor facing parental involvement is the idea that some well-meaning school staff members feel that they have been delegated as the educators of children and the sole responsibility for education is in their hands. Seely proposed that this idea of delegation has been subconsciously signaled to the parents so that they do not need to be involved in their children’s educational experiences. In brief, Seeley’s study concluded that one must convince all involved in the child’s education that parental involvement is essential to the education process.

This study further implied that once parents and teachers understand the importance of parental involvement, they will be willing to commit do doing all that is necessary to achieve the identified goals. Davies (1998a) revealed that the growing number and variety of students’ ethnic, economic, and social backgrounds make reaching out to families increasingly complex. Educators who think only in terms of traditional families are likely to have a particularly hard time dealing with today’s great variety of family types.

Davies suggested that educators must face their own misperceptions about parents. However, a child born to parents who are mature, educated, employed, and married is statistically more likely to do well rather than a child who lacks that family support, even if the child is exposed to a host of government intervention programs. Parenting Styles and Ethnicity According to Coolahan, McWayn, Fantuzzo, and Grim (2002), parenting styles differ based on ethnicity and are also determined by parents’ characteristics.

Parents from different cultures may have different characteristics and may, therefore, use different parenting styles when raising their children. For example, ethnic differences have been found in the acceptance of spanking. Thus, there may also be ethnic differences in parenting (Pinderhughes, Dodge, Bates, Pettit, & Zelli, 2000). Research has found the authoritarian parenting style to be more common among African-American families than European-American families (Clark & Gross, 2003). Families from the same SES group but from different ethnic groups have been found to have differing levels of stress.

For example, African-American families with low SES report higher levels of stress than European-American families with the same SES. This could be due to the fact that African-American families are also vulnerable to additional race-related stressors (Pinderhughes et al. , 2000). The Asian-American culture differs from European and Mexican-American cultures. Studies have shown that the styles of parenting used among Asian-American families may differ significantly in some areas. For example, Liu (2003) found two main types of parenting styles among Asian-American families.

They are care and overprotection. When parents use the care styles of parenting, they are affectionate, emotionally warm, empathic, and close to their children. However, many Asian-American families use a style of parenting that closely resembles an authoritarian style called overprotection in which parents strictly enforce rules and discourage independent behavior. The overprotection style of parenting is comprised of parental control, overprotection, intrusion, excessive contact, and prevention of independent behavior.

Other studies have found that the families who use the care style of parenting are closer and more functional with each other (Kee, Sim, Tech, Tian, & Ng, 2003). They also found the families who use the overprotection style of parenting to be more dysfunctional on the average. Other studies on parenting styles and ethnicity have found African-American families from low SES groups to have a more punitive attitude towards their children because of the higher levels of stress they experience (Pinderhughes, et al. , 2000). This attitude would lead to a more authoritarian style of parenting.

Authoritative parenting predicts good psychosocial outcomes and problem behaviors in all ethnic groups and is associated with increased academic performance (Steinberg, Darling, & Fletcher, 2005). Parenting Styles and Their Relationship to Discipline Parenting styles begin determining, to a significant degree, how a child will develop at a very early age. For example, with infants, sensitive, responsive maternal behavior is associated with healthy and secure mother-infant relationships (Isabella, Belsky, & von Eye, 1999).

According to Schaefer (2000), parenting style is the single most important factor associated with conduct disorders. Behavioral instability and non-optimal parenting across four generations was examined by Gosche (2005), and it was reported that non-optimal parenting is reproduced in subsequent generations due to the development of unstable behavioral styles in children exposed to poor parenting. Children who are exposed to more hostility from their parents are more likely to display aggressive behavioral styles as adolescents and adults which, in part, cause their aggressive and hostile behavior toward their children (Gosche).

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Parental Involvement And Its Relationship To Discipline In Elementary Schools Essay

Dr. patient relationship Essay

Dr. patient relationship Essay.

For quite a long time doctors have the freedom to interfere and dominate the patient’s desires with the sole objective of avoiding harm to the patient . The emphasis in today’s medical practice is individual independence and control and medical paternalism no longer enjoys the indubitable acceptance by the society as the dominant approach to decision making in medicine. But neither is a decision-making approach that is based on absolute patient autonomy a satisfactory one. A more ethical and tested approach is to facilitate a patient’s autonomy by advocating a medical beneficence that includes patients’ ideas and perspectives .

This can be accomplished via a model for shared decision making recognizing the fact that the final decision lies ultimately with the patients and that it is only through the doctor’s beneficence that the patient can be empowered to make meaningful and sensible decision that work best for them. For such a model to be efficacious, the return of trust to the doctor patient relationship and patient doctor communication are both important.

Introduction The benefit of the patient has been a major preoccupation of the medical profession for a long time.

The Hippocratic oat stipulated that the physicians will do their best not to injure the patient and also to restore the patient to their healthy state. Generations of physicians have sworn to this oat. The perspective of the patients about physician is that of guidance with professional skills, knowledge and training to benefit the patient including making unilateral decision about what constitute benefit to the patient. The situation is therefore comparable to that of a caring father and a child and hence the use of the term paternalism. Medical beneficence stood for a long time as the operation mode for doctor patient relationship.

Such relationship work well as it represents the essential role of medicine in the society. Since the beginning of few centuries ago, there has been a shift to the individual away from political and religious authorities. Similar changes are experienced in medicine as orchestrated by difference in the tone of the ethical codes of America medical association (AMA) in the last two centuries. Considering the article II of the 1847AMA ethical code entitled “Obligations of the Patients to their Physicians”, Section 6 stated that “The obedience of a patient to the prescriptions of his physician should be prompt and implicit.

He should never permit his own crude opinions as to their fitness, to influence his attention to them. A failure in one particular may render an otherwise judicious treatment dangerous, and even fatal. ”On the contrary AMA’s opinion in 1990 on “Fundamental Elements of the Patient-Physician Relationship” now states a completely different position:“The patient has the right to make decisions regarding the health care that is recommended by his or her physician. Accordingly, patients may accept or refuse any recommended medical treatment.

” in today’s practice, the principle of autonomy of the patient and self determination has emerged as the dominant ethos In health care, threatening in many instances to totally eclipse the principle of medical beneficence. The simple pendulum has taken such a drastic tilt that, with the exception perhaps of soft feeble paternalism with respect to non-autonomous patients, paternalism is almost always seen in negative light, regardless of its intention and outcome. But medicine is, after all, a human activity aimed at healing and restoration of health.

The question now is that can medicine therefore continue to serve the patient if cleansed totally of a paternal motivation? In an essay written by Tan , validity of medical paternalism was rejected and he debated violently on its deconstruction. By giving a passionate support for a patient autonomy against “excessive expression of beneficience”, many of Tan’s views are nonetheless less than persuasive as it can be invalidated. For instance he gave a real life example of a physician who was said to be unwell singularly on the ground of noncompliance.

This is a rare scenario . Also it is hasty to have declared such patient as incompetent and hence the disqualification from making decisions as there was no legal process which include any preexisting psychopathology and a complete assessment of the cognitive functions which are mandatory to determine the incompetence or otherwise of a patient. Another example would be Tan’s accusation that the move by Singapore’s Health Ministry to regulate the practice of the traditional Chinese Medicine (TCM) was a “laughable” one .

He seems to have omitted the fact that irrespective of the review methodology used, any system of medicine that is seeking acceptance and official acknowledgment in society should be able to make provision for appropriate level of assurance to the public in terms of how safe its practices are and also the minimal standards of its practitioners. Such thoughts are not what Tan describes as“Western medical criteria”, but are instead very basic representative standards demanded by regulatory leaderships to ensure public safety.

The choice of Society over which system of medicine it adopts as its mainstream, be it allo- or homeopathic (complementary disease treatment system), empirical or experimental, is hardly a result of paternalism in Western medicine. But Tan however is right in suggesting that there is a need for the ‘western-trained’ doctor to utilise an open mind to alternative schools of medicine. This can only extend as far as a sincere admission of ignorance and a commitment to critically examine any available evidence.

Modesty cannot and should not equate unfounded ratification of and recommendation of therapies for which a doctor is void of understanding or conviction. For that group who vehemently oppose beneficence as the reason and justification to overrule patients’ choices, a model advocating supremacy of individual freedom and autonomy is advocated. In this approach, which some people call the informative model. Physician’s role is relegated to that of a technician who provides patient with information and leaves the patient to decide. The model is assumptuous. It assumes the physician role in patient doctor encounter to be passive.

It is sadly simplistic view of the profession’s essential roles, duties and responsibilities (Adelaja, 2003) Admittedly although sadly, some doctors are found guilty of promoting this impression and therefore neglecting the essential humanistic aspect of the practice. Furthermore, physicians who are dreadful of the consequences of not respecting and recognizing the autonomy of the patient have been known to adopt such a model. This can eventually lead to a total neglect and dereliction of their professional responsibilities, with a possible danger of administering therapies that are not medically indicated or relevant.

By trying to honor autonomy and freedom, physicians merely offer possible options with no professional contribution in addition, and so this informative model is unlikely to serve patient’s interest. In this kind of system, even non-coercive trial to discuss with patients the advantages and disadvantages of their decisions can be considered a total violation of their rights or freedom when in fact, such efforts sincerely reflect appropriate care and emotional concern for the patient’s well-being.

“This model of clinical encounter is therefore unsatisfactory as it can lead to a form of moral and professional neglect by the physician” (Pellegrino, 1976,pg37). Another thing is that the model assumes all competent individual being capable of management of their daily affairs and events based on their beliefs and experiences which also include decision making capacity about their health. Tan in 1978 cited that illness does not have effect on the cognition and the emotion and that patient can therefore make decision about the treatment they receive.

We now know that sickness does not affect or lower the rights and morals of a patient(olumuyiwa,2003). However the ability to make informed decision is affected by the biopsychosocial effect of the illness(Engel,1989). To confirm a person as incompetent there must be demonstrable psychopathology and mental incapacity. Steven wears noted in his works about informed choice in health care that if only for freedom and control ,without thinking well on their own choice, it will be hazardous for patients to exercise autonomy rights and therefore overrule the choice of the doctor.

Freedom without moral responsibility is counterproductive to the goals and objectives of medicine. A better service could be rendered to patients by minimizing paternalism without so much compromise on the freedom of the patient. Tim further acknowledged though famishly the model to deconstruct or critically analyze paternalism when he said that the exercise of autonomy “may fulfill patient’s expressed desire but not necessarily transform into serving the patient best ,if at all” .

In lim’s own view, hard paternalism is not prevalent in the medical practice of today and that most people are the so-called “grey cases” (dismal). He used the word “ guided paternalism” as a model to better serve the patient and the aim is to facilitate and enhance the autonomy of the patient. The approach recognizes patients as having the final say in decision making as they are responsible for whatever outcome of their decision . It however emphasizes the duties of the patient and the professionalism of the medical team.

The model is a deliberative one and sees the physician as the tutor who clarifies patient’s values and help in the processing of possible intervention. A model like this that takes professional guidance into consideration is relevant for the computer age that we live where patients are equipped with medical information gotten from the internet even though the information is raw and invalidated. The model is consistent with what Thomasma and Pellegrino put forward as “true benefit”.

It holds that the doctor’s assistance in patient’s decision making should cut across enhancing the patient’s capacity with respect to the reasoning ability of the patient. There is therefore congruence between autonomy and baneficience. In this deliberative otherwise known as the shared model, there is a need for mutual trust between doctor and the patient Hard or absolute paternalism is no longer popular because of the waning public trust and regard for medicine. The pluralistic society also sees paternalism as unethical and diabolic.

The shared model of patient doctor relationship also has a lot of advantages and the patients and doctors should therefore first be educated on the enormity of the problem. Doctor- patient relationship should be a form of partnership. Under the shared model, Patients need to be enlightened on the importance of a good doctor patient relationship. Time and finance has been a major drawback to shared decision making in health care system. Such problems need to be solved .

The communication gap between patients and doctors should be bridged to allow for patient participation in decision making pertaining their health. Patient should learn to be responsible for their healthcare and they should comply with treatment and should not withhold their trust even in the presence of obvious medical uncertainty. “There is no real need to make an absolute distinction between Paternalism and autonomy and to prefer one over the other” (Davehere, 2000). The drive behind paternalism is beneficence, seeking for the good of the patient.

Autonomy on the other hand is based on the fact that patient are responsible for whatever decision they make and should face the consequence. The best approach therefore is the one that mingles Autonomy with beneficence. By sharing the process of decision making, the precision and wealth of patient’s choice can be facilitated by doctor’s advice. The doctor is not patient’s messiah . Similarly; he is not just a mere technician with education. The doctor is indeed the friend of the patient. The doctor cares for the patient as they voyage towards comfort, cure, deliverance and relief.

References Code of Ethics. American Medical Association, 1847. Devettere RJ. Practical decision making in health care ethics: Cases and concepts. 2nd Edition. Washington DC: Georgetown University Press, 2000 Lim SL. Medical paternalism serves the patient best. S Med J 2002; 43(3):143-7 Olamuyiwa, O (2001, pg278). Introduction to Psychiatry, Oxford University Press. Pellegrino ED, Thomasma DC. The virtues in medical practice. New York: Oxford University Press, 1993 Tan NHSS. Deconstructing paternalism – what serves the patient best? S Med J 2002; 43(3):148-51

Dr. patient relationship Essay