• S C Ratzan.
• Emerson College-Tufts University School of Medicine Program in Health Communication, Boston, Massachusetts, USA.
• Neurosurg. Clin. N. Am. 1995 Oct 1; 6 (4): 809-16.

AbstractThe major changes in health care delivery today further cloud the perspectives of patient autonomy, participation, and justice and the ideals of the virtuous practice of medicine. A Workable Integrative Negotiation approach with COAST permeating the medical setting and health agenda, however, can help promote effective and ethical participatory communication in medicine. Clearly, instituting such change in a non-surgical decision-making procedure requires a new culture among all participants. The case of traumatic injury provides an excellent back-drop for employing ethical decision making which in the long term can help usher in the most efficacious, ethical treatment for the individual, physician, and society. Additionally, today's omnipresent changes in medicine can help advance ethical directions in health-care decision making. For example adding ethical decision making and negotiation education in curricula for those in medicine, along with allied health professionals, and those who might become patient advocates or serve on ethics committees, can initiate a change in medical decision making. Full-fledged tort reform that allows all alternatives protects physicians and patients when the appropriate decision "to not treat or intervene" is rendered can be an important step toward a healthier society. Instituting an outcome-based reimbursement system among government and providers can serve as a quasi-selection process based on the superseding objectives of the community at large. Finally, a participatory citizenry (from physicians to patients to society-at-large) that balances violence prevention, communication, innovation, community involvement, and appropriate treatment could advance optimal civic health. The challenge is to initiate such change with the communication principles outlined herein.

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