Every human being is unique and thus has different ambitions and most importantly has a

different perspective on what well-being means to them personally. Therefore, one could
speculate as to whether a health care provider truly knows (or claims to know) what is best for
their respective patient. A physician is someone trained professionally in the medical field and
therefore has considerable and insightful knowledge pertaining to medical health. However,
well-being in general, cannot be medically assessed thus it is in some ways segregated from
medical health. The issue arises when one asks the following question: if a physician is
professionally trained in medical health, can they still hold a valid opinion about the well-being
of their patient and present it to them? 1 According to Groll, when medically assessable
disagreements arise, the physician knows best simply based on their immense medical expertise.
However, even if the disagreement is nonmedically assessable, the physician still holds a special
obligation towards their patients as a health care provider and also since they are (most often
than not) psychologically healthy individuals. Grolls claim that physicians hold a special
obligation for helping the patient and also know best as psychologically healthy individuals
seems reasonable to the extent that medical wellbeing is promoted, however, a conflict can arise
where another individual, influencing the patient with regards to a different aspect of wellbeing
also claims to have a special obligation and even that they too know what is best for the patient.
Groll contends that there are scenarios in which disagreements arise, and in order to make the
value judgements on part of the physician and the patient easier, these disagreements can be
divided into two categories: disagreements about ends or disagreements about the means to an
end.1 End disagreements relate to whether the physician and the patient in question have the
same goal, in other words, what constitutes wellbeing for the patient and the physician. Meansend disagreements occur when the physician and the patient have the same goal, however they

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disagree as to how that goal should be met.1 Clinically speaking, the first relates to the results the
patient expects after or without the treatment while the latter relates to how best to achieve those
results.1 Groll then goes on to say that these two categories seem quite distinct on paper;
however for practical purposes as in health care, they can seem quite confusing and one could
imitate the other. He resolves this issue by stating that health could mean quite different things
to the patient and the physician especially when overall wellbeing is considered.1
According to Groll, physicians or health care providers in general, are experts when it comes
to medical health. As such, Groll presents us with a taxonomy of clinical disagreements which
can be used to categorize the disagreements into a matrix form, therefore when a physician is
confronted with a disagreement with a patient, the disagreement can fall into two categories
namely: medically assessable (means-end disagreements) or non-medically assessable (meansend or end disagreements).1 Groll argues that when it comes to medically assessable
disagreements about a particular means to an end (treatment options), physicians can confidently
hold to the claim that they know better for the patient in relation to their health since they are,
presumably, experts in medical diagnosis, prognosis and treatments. Even so, when it comes to
non-medically assessable disagreements the physician cannot claim to know better based on their
training as a health care provider; rather they can justify their opinion-giving by rational common
sense which most people possess.1
Using the concepts of medically assessable means-end disagreements and end disagreements,
physicians can determine the treatment plan for their patients. If the patient disagrees and if it is a
medically assessable means-end disagreement, according to Groll, the physician, possessing
substantial medical knowledge can hold true to the claim that they know best and that they
should ultimately use their medical expertise to guide the patient towards a particular treatment

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plan. If however, the disagreement is a nonmedically assessable means-end disagreement the

physician cannot use medical reasoning, only rational thought (common sense) to guide the
patient. Groll gives the example of a patient who disagrees with the physician for an amputation
of a gangrenous toe on the grounds that God will save him. The concept of God lies outside of
medicine therefore empirical knowledge is not a way of convincing the patient .Groll argues that
end disagreements (if properly understood) cannot be medically assessed since, medical science
cannot determine what values in life for people.
The example that Groll uses is of a patient with a gangrenous toe, discussing with his physician
as to what he would like to do about it. If the patient directly states that it is important for them to
live and then die in a complete body (even with the gangrenous toe), the physician cannot argue
using medical reasoning that it is better if they live without the toe, since the patient might have
some ideological obsession with a complete body that cannot be understood medically. This is a
case of ends disagreements in which only rational thought (common sense) is convincing and
where most people would agree that it is bad for the patient to refuse amputation and then die. If
however the patient says that they want to be free of gangrene however without the amputation,
but rather using a natural cure, the physician can object to this and support their position using
empirical medical data that suggests that amputation is a much more successful procedure than
natural methods (which have not been tested as much if at all). In the case of differing about
ends, the physician might not be able to use their medical expertise to guide the patient, rather as
Groll states they can share their opinion as normal psychologically healthy people.1 Suppose a
newly diagnosed cancer patient is given direction by his physician to immediately start
chemotherapy. But this patients wife is at the final stages of cancer and she is predicted to die
within the next month. In this case, the physician cannot say to his patient that it is better for you

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to undergo chemotherapy now and not spend time with your wife as opposed to spend quality
time with your wife in her last days and then start your treatment (chemotherapy). Even so, Groll
argues, just because physicians do not hold expertise in what matters best in life for their
patients, they can still share their opinion considering they are normal, healthy and well
intentioned individuals and more importantly hold a special responsibility towards the patients
well-being in general.1
Most patients discussing their medical health with physicians tend to believe that physicians
are very knowledgeable people or at least experts in medicine. This is true as Groll argues,
however he also warns of a situation in which a physician can take advantage of this trust that a
patient has and use it to give opinions with the same amount of credibility regarding matters that
cannot be determined using medical science. He helps the physician out by saying that
physicians can, in matters that cannot be understood medically as in the example mentioned
above of the wife in her last days, resort to other people (like priests, family members, relatives
et cetera) who are in a better position to help the patient out whether spirituality, emotionally or
religiously and bring them around to the better course of action. 1 These people could be
friends, family, social worker, or priests who help the patient when the conflict lies outside the
purview of medicine (nonmedically assessable end disagreements). 1
Groll states she (physician) often does not know what is best for her patients, various
options are available to her, and not simply as someone who happens to know best, but as
someone who, nonetheless has a special responsibility to the patient as a clinician.1 This
statement reemphasizes Grolls position that even if the disagreement lies outside of the scope of
medicine and is regarding ends, the physician should still help the patient out as a health care
provider tasked with a special responsibility towards the patient and also as a psychologically

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healthy member of the community.1 This creates a problem regarding the issue of well-being and
most importantly raises the question of why do physicians have a special obligation (and if they
do) who else also has a special obligation? Physicians are primarily concerned with medical
well-being and therefore prioritize medical well-being over all other types. The reason for this is
quite simple, physicians train as health care providers who have extraordinary knowledge about
medicine, however they do not train as psychologists, priests, social workers, or other types of
people concerned with wellbeing in a different respect. Suppose a physician recommends an
alcoholic syrup for the common flu to a Muslim patient since this particular syrup has been the
most successful statistically (at relieving symptoms), however the patient refuses since it
contains alcohol which they cannot consume in their religion. The fact that statistical evidence
supports that this particular syrup is the best, reinforces the medically assessable aspect of the
disagreement, that is, the physician knows best with regards to medical wellbeing. However the
patient is refusing since it conflicts with their religious or spiritual wellbeing. If this is the case,
then in the eyes of the patient, spiritual wellbeing has precedence and moreover the physician
does not hold a special obligation in the patients opinion to their overall wellbeing. Most people
however do not feel the same way (at increasing medical wellbeing to the maximum), and the
reason is although we want to be healthy, we do not want to be perfectly healthy if it results in a
trade off with lets say familial, ideological or economic aspects of well-being. Lets take the
case Groll gives us of Mr. Johnson. Suppose the physician is unable to convince Mr. Johnson
because he values dying with a complete body than live with an incomplete body and lets also
suppose that this is because of Mr. Johnsons adherence to an obscure ideological (religious)
belief in that whatever his priest says goes. His priest says that if you (Mr.Johnson) die with a
complete body you will go to heaven which is eternal and which will ultimately make you forget

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about this limited torture (pain) that you will experience dying with gangrene. For Mr. Johnson,
the idea of eternal bliss is much more attractive than living with nine toes and losing the chance
to go to heaven. Also, most importantly, Mr. Johnsons priest can also hold to the claim (like the
physician) that he has a special obligation for the well-being of Mr. Johnson even though for
most of us it seems ridiculous, but again this is Mr. Johnsons life. Thus we can see that both the
physician and the priest claim to hold a special responsibility for Mr. Johnsons wellbeing and
this is true, but the aspect of responsibility they hold with regard to Mr. Johnsons well-being
differs greatly. The physician is primarily concerned with well-being in the medical sense while
the priest is concerned with well-being in the religious or ideological sense. So whose claim of
well-being takes precedence? Well, its up to Mr. Johnson to decide.
Grolls stance regarding the special responsibility on part of the physician towards the patient
could potentially conflict with another individuals claim to holding a special responsibility as
well. This is primarily because the aspects of wellbeing that the physician advocates (medical)
could possibly conflict with other aspects like religious wellbeing. Groll states She (physician)
might also reach out to others who are, perhaps, in a better position to engage the patient in a
substantive conversation about what is best for herfriends, family, social worker, or priest, for
examplein the hopes they will bring the patient around to a better course of action. The
statement at the end seems precarious especially when Groll says in the hopes they will bring
the patient around to a better course of action. Groll assumes that people associated with
different aspects of wellbeing would ultimately agree (more or less) with what the physician is
claiming is best for the patient. This is simply not true in certain cases, where the adherence to
nonmedical aspects of wellbeing is so powerful that it triumphs over the medical aspect. I would
ask Groll to lay emphasis on medical wellbeing of the patient and how the physician is an expert

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in this particular facet, however as far as special responsibility is concerned, many people in a
patients life can hold true to that claim as well. Ultimately however, as Groll agrees, the final
decision is up to the patient and whichever aspect of wellbeing the patient considers most
imperative is their personal decision.

References
1. Groll, Daniel. "What Health Care Providers Know: A Taxonomy of Clinical Disagreements."
The Hastings Center Report 41:5 (2011): 27-36. Print.

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