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Disputing with patients in person-centered care: Ethical aspects in standard care, pediatrics, psychiatry, and public health

Munthe, Christian; El-Alti, Leila; Hartvigsson, Thomas; Nijsingh, Niels


Christian Munthe

Thomas Hartvigsson

Niels Nijsingh


This article explores ethical aspects of using open argumentation in person-centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences, or value commitments of patients. We argue that such disputing may be claimed to have an important place in advanced versions of PCC, but that it actualizes important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry, and public health interventions, such as antibiotic stewardship programs, as examples. These contexts offer new reasons for why PCC may or should include open disputing with patients, but also introduce new ethical complications. Some of these may transform either to arguments against PCC implementation in these areas, or to a more open view of the extent a HP may seek to dominate patients in a PCC setting. We are especially skeptical of the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of compulsory elements, such as forensic psychiatric detention.

Journal Article Type Article
Online Publication Date Oct 12, 2018
Publication Date Oct 12, 2018
Deposit Date Nov 7, 2022
Journal Journal of Argumentation in Context
Print ISSN 2211-4742
Electronic ISSN 2211-4750
Publisher John Benjamins Publishing
Peer Reviewed Peer Reviewed
Volume 7
Issue 2
Pages 231-244
Keywords antibiotic resistance; forensic psychiatry; patient-professional relationship; shared decision-making; vaccination
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