In their essay on nonabandonment, Quill and Cassel [1] argue that the conventional construct of medical ethics constrains our thinking and flexibility in caring for patients. They then propose that the physician-patient relationship be at the core of a new ethical paradigm.

In fact, the core of their discussion is not ethics but the physician-patient relationship. Although the authors devote much attention to "relationship" and nonabandonment as sources of ethical principle, they offer little insight into the phenomenology of relationships or the experiential aspects of being a physician. What about doctoring makes connections with patients rewarding, intriguing, joyous, tedious, burdensome, or boring? One would expect that technical competence, curiosity, an understanding of human behavior, and the capacity to discover novelty in the routine would facilitate professional satisfaction and nurture the physician-patient bond.

In the absence of such an understanding, the path from relationship to ethical paradigm is based on little more than the feeling states of physicians and patients. In this context, almost any action would be ethically correct if it "felt right" to the consenting parties. This resonance of feeling and understanding in the physician-patient relationship would then gain a moral legitimacy such that euthanasia, assisted suicide, and other controversial treatments would logically flow into the armamentarium of the physician. Does medicine need this new ethical paradigm? Or would we gain far more by investigating the experiential and behavioral aspects of the patient–physician relationship, determining its therapeutic and healing elements, and incorporating these new insights into our practices?