Why patients have a moral obligation to give care to clinicians.

Progress is being made in transitioning from clinicians who are torn between caring for patients and populations, to clinicians who are partnering with patients to care for patients as people. However, the focus is still on what patients and others can do for patients, however defined. For clinicians whose interests must be similarly respected for their own sake and because they are integrally related to those of patients, what can and should patients do? Patients can be exempted from some normal social roles but are generally recognized to have moral obligations in health care. One of these obligations is caregiving to clinicians within the limits of each patient's capability. My paper moves this obligation beyond the ceremonial order of etiquette characterizing public statements on how patients should relate to others. It goes beyond a patient-centred ethic that is consumerist in nature, to a person-centred one that recognizes patients typically as moral agents who are dignified by recognizing the obligation to give as well as receive care as sincere benevolence. This obligation derives objective justification from divine command. It is also consistent, however, both with what people, if ignorant of their social role, would objectively produce for a hypothetical social contract, and with virtues constitutive of human nature and a relational and communitarian understanding of what it is to be a person. Including sentiment (intuition) and personal conscience, this relational identity makes caregiving intrinsically meaningful, yet caregiving also has an instrumental value to patients and clinicians. Its self-enforcement by patients will depend on their moral code and on society making caregiving achievable for them. A moral obligation for patient caregiving may then be specified to require patients to reflect on and invest in relationships in which they can feel and show care for others sincerely and respectfully.