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The article explores the model of patient ’s good by E. Pellegrino in the work with teenage mothers in the field of medical - social work. The patient’s good is viewed as a hierarchical structure based on four levels of human existence. It includes the medical good, personal good, human good, and spiritual good. A medical good is aimed at maintaining the physical health for teenage mothers. A personal good is unique to every teenage mother - this is a good, that is defined by a patient himself, his personal preferences, personal choices, values. A human good is a good of teenage mothers as a representative of the human race. A spiritual good represents the highest level of a good in the interaction between a doctor, a social worker and a teenage mother. A spiritual good is provided by three lower levels of a good. A good as integrity is a goal of the professional activity connected with the rendering help for people (medicine, social work, pedagogy, clinical psychology).

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Physician and social worker should work as a team and work out together the strategy for team - work with a particular patient. They also should formulate the ethical rules for the “physician - patient” relation” in every individual case [3]. Their team - work should focus on the general goal. Generally the goal of medical - social work means the attainment of the highest possible level of health, the function and adaptation for the persons with physical and mental disorders and for those who are socially deprived. This paper deals with the particular situation when the patient is a teenage mother and the work with this patient aims at the teenage mother’s good and her child’s good and health. For this purpose it is necessary to formulate moral regulations for the physician and social worker’s behavior with teenage mother [1]. We consider that for the effective team work in the “physician - social worker - teenage mother” relationship it is necessary to use the four - level structure of good proposed by E. Pellegrino: the patient’s good is composed of four levels and it is viewed as the complex relationship between medical, personal, human, and spiritual good. These levels of good are placed in the hierarchically order. The ancient dictum "do good and avoid evil” is the indispensable transcendental ground for any ethical system, because the good is the goal of moral science, and this basic principle makes the difference between moral sciences and other sciences. Thus the patient’s good is the destination of any medical activity; it is the result which medicine by its definition works for; the result which identifies medicine [6]. The team “physician - social worker” works with a teenage mother for the maintenance and support of her health and psychological comfort. To achieve this result it is obligatory, in the first place, to reach the nearest result. This result means making correct bioethical decision in the “physician - social worker - teenage mother” relationship and applying this decision safely for the patient. Every adolescent mother needs this particular result, and a physician and social worker are ordered to achieve this particular result.The result of the activity of 19 any physician and social worker is the teenager mother’s good as a whole. Physical, emotional, human, and spiritual parts of teenage mother’s personality should be taken into consideration. As stated before, good represents four - component scheme. It is based on four levels of human existence: the first level is the medical good; the second is the personal good (teenage mother’s personal preferences); the third level is the teenage mother’s human good. The fourth (the highest level) is the spiritual level of the teenage mother. Thus the good represents itself the hierarchical structure, in which every level should appropriately correlate with other levels [2].The medical good is the good which relates most directly to the art of medicine; this part is exclusively medical part. The medical good aims at the maintenance of teenage mother’s somatic health using medical treatment, surgical intervention, physiotherapy treatment, etc. At this level the teenage mother’s good depends on the right use of the physician’s knowledge and skills. But the medical good must be brought into the proper relationship with the other levels of the teenage mother’s good. Otherwise it may be harmful. Medical good based only on the physiological effectiveness may not be good, if it violates higher levels of good, like the teenage mother’s personal good. Teenage mother’s personal good as she perceives that good presents the second level of teen mother’s good.At this level we are concerned with the adolescent mother’s personal preferences, her personal choice, decisions on the benefit and burdens of the proposed intervention. Personal qualities are unique for each teenage mother and cannot be defined by the physician, the family, or anyone else. They are determined by the tender years, new social role, mother’s role, new real - life situation, etc. To serve the general good of the patient, the medical good must be placed within the context of this teenage mother’s life - plans. Medical good and personal good of the teenage mother should be related to the human good of teenage mother. At this level we consider the good peculiar to humans. Respect for dignity of the teenage mother, respect for teenage mother as a human are inherent components of this level and must not be determined by teenage mother’s social background, education, level of material prosperity, etc. A teenage mother, a physician, and social worker are people who are bound by solidarity and mutual respect.In the communication with a physician, social worker and teenage mother the medical good and personal good must not contradict with the human good. Medical good and personal good should protect human good. Professionals who ignore the teenage mother’s opinion violate the good (the right) of the teenage mother to be self - determining rational being. Denial of care to the poor teenage mother violates her dignity and value as human beings. Putting a teenage mother at risks that outweigh potential benefits, even with her consent, violates the duty of beneficence and avoidance of evil. The highest level of good in the team - work of physician, social worker with teenage mother is the good of the teenage mother as a spiritual being (spiritual good), i.e., as one who acknowledges soul and spirit. This realm of spirit gives ultimate meaning to human lives. From the perspective of natural law, the spiritual destiny of human being is his highest and ultimate good [7]. Whatever the origin and content of one's spiritual beliefs, the three lower levels of good which have been described before must support the spiritual good. One of the complex examples is a teenage mother’s child adoption by her mother. In this case for one teenage mother this personal good may not be good as it violates her highest good, but for another teenage mother it determines her highest good. Bioethics imposes duties upon a physician and social worker to assess each of the four levels of teenage mother’s good and establishes the order of priorities among them. For this purpose it is obligatory to be aware of teenage mother’s personal preferences and moral principles [6]. The individual spiritual good of the teenage mother should be included in the process of rendering help by physician and social worker if it serves the teenage mother’s good.Consequently serving the human good is common for all helping professions (physician, pedagogue, social worker, clinical psychologist, etc.). Good is the mission of their professional activity. Minor results may be different for each professional; it depends on the particular activity specific to each profession. Whatever the minor results are, certain virtues and moral principles are necessary for each professional in the field of helping people to reach the four - level good of the patient. The advancement of the concept of the patient’s good in the unity of its spiritual and medical components, the realization of this concept into the medical - social practice become the perspective directions of scientific investigations on bioethics in our country.

About the authors

E. A Reymer

Volgograd State Medical University

Email: ekaterina.reimer@gmail.com
postgraduate of Department for Philosophy, Bioethics and Law with the course of sociology of medicine


  1. Реймер Е.А., Кантемирова Г.А. К вопросу об этических правилах медико-социальной работы с несовершеннолетними матерями // Биоэтика. - 2015. - № 1 (15). - С. 40 - 43.
  2. Реймер М.В., Жура В.В., Сергеева Н.В. Благо пациента как предназначение медицинской деятельности // Биоэтика. - 2012. - Т.9. - № 1. - С. 18 - 21.
  3. Тигишвили Н.Н., Лакеев А.Е. Этика взаимоотношений врача - эксперта и социального работника // Биоэтика. - 2013. - № 2 (12). - С. 42 - 44.
  4. Beauchamp Т.L., Childress J. Р. Principles of biomedical ethics. - NY. - 2001. p. 254.
  5. Pellegrino E.D. and. Thomasma D. The Virtues in Medical Practice. - New York: Oxford University Press. - 1993. - P. 255
  6. Pellegrino E. The “telos” of medicine and the good of the patient // Viafora C. (Ed.). Clinical Bioethics. A Search for the Foundations. Springer. Printed in the Netherlands. - 2005. - P.3 - 20.
  7. Pellegrino E.D., Thomasma D.C. A Philosophical Basis of Medical Practice. New York: Oxford University Press, 198 1; and For the Patient's Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press. - 1988. - P. 526.

Copyright (c) 2016 Reymer E.A.

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