Health Care Hostage: Ethical dilemmas in chronic illness care

This paper will propose a patient role exists the author will call a health care hostage because of dependency on medical care created by a serious chronic illness or a serious traumatic injury, requiring on-going close medical monitoring with multiple specialists in a health care institution or system. This dependency causes the patient to become captive to the medical institution in which they receive care. Patients must stay within the “sick role” defined by Talcott Parsons. If they deviate from prescribed role boundaries, retaliatory actions are taken by medical professionals intending to bring the patient back under their social control and management. The deviant patient is often morally judged, labeled by the treating physician(s) as “difficult” or other pejorative labels, their management is treated as “dirty work”, and physicians may behave in unethical ways toward them. Ill patients are unempowered and hesitant to leave undesirable health care relationships to begin again with new practitioners, and thereby, become hostages to physicians who morally judge them and treat them poorly. Patients know it is in their best interest to stay in a less than desirable relationship with a physician(s), concealing their resentment. The ensuing relationship(s), with extreme power imbalances, becomes similar to the psychopathology of spousal abuse, sexual harassment, hostages, prisoners of war, and incest. The impaired physician-patient relationship affects the quality of medical management of these patients, culminating in poorer health outcomes.