The ‘Good’ of the Patient: Whose good is it? How can we approach it? Why does it matter?


In my first article, I introduced a method of understanding health and happiness through a trusting relationship of care and empowerment. I discussed the prescription of ‘homework assignments’ aimed at becoming personal habits that serve as a basis for achieving health and well-being. I also introduced a concept of the patient’s ‘good,’ which I will expand on in this brief article.

I hope to reach my audience in many ways as I write. Some articles will offer a basic insight into medical care. Others will provide practical advice based on medical science and clinical experience. Still, others will focus on how we can improve the delivery of care within our local community. My writings reflect my personal, educational, and professional background and the insights these have provided in my understanding of the medical profession and the care of patients. As such, some of my writings will rely on my interest and knowledge of the history of medicine, medical ethics, and the philosophical basis of medical practice. This is one of these articles.

Understanding and acting for “the good of the patient” is an ancient and universally acknowledged principle in medical ethics. What makes The Good difficult to comprehend is the various influences and need for more consensus on what constitutes the good life in our pluralistic society. When caring for my patients, I often try to ascertain how they define the good life. Patients often share that this has not been customary in their recent encounters with the healthcare system. However, I believe having a framework with which to understand the patient’s good is essential as patients try to understand illness within the context of their lives.

One theory of the good of the patient relies on a fourfold meaning proposed by Dr. Edmund Pellegrino1. This framework can be used in each patient and physician clinical encounter. The patient seeks the help of another to restore health or to cope with illness. The patient hopes to return to a way of life that allows for the pursuit of personal goals and happiness. This is the end a physician commits to serve through a trusting relationship.

For Pellegrino, we should examine four tiered goods when caring for the patient. At the lowest level is the biomedical good. This level is related to the knowledge and competence of the physician who relies on medical science and technology to restore physiologic dysfunction by applying appropriate medical care and treatment. This good is important but narrow in understanding the good of the patient as a whole.

The second level is the patient’s perception of the good or the patient’s understanding of what is best for herself or himself. Faced with similar diseases or treatments, patients make different choices, and their personal preferences should be considered.

The third level is the protection of the dignity of the human person regardless of age, gender, race, or social status. This good is grounded in a patient’s capacity as a human being to reason and freely express choices. Humans who, due to physiological abnormalities of brain function, cannot readily make or express choices must be represented by those whom they have entrusted with their care but must be represented in their dignity nonetheless.

The fourth and highest level is seeing the patient as a transcendental being. This is the ultimate good of the patient and to some can be considered a spiritual good. This good involves the patient’s view of the meaning and destiny of human existence and that which gives meaning to life and beyond.

While reconciling these four levels of the patient’s good in every clinical encounter is not always easy, they should be considered and prioritized. Medical advice, therapeutics, and care should aim to address these levels of the patient’s good. Homework assignments are only as good as the educational goods they achieve. Likewise, healthy habits and medical treatments are instrumental as they promote the patient’s good as a whole.

1Pellegrino, Edumund D, and David C Thomasma. 1988. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press.

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