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                                                                                         Bangladesh Journal of Bioethics 2021;12 (1):14-24 

 

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The Case of Doctor-Patient Relationship in Bangladesh: An Application of 

Relational Model of Autonomy 
 

Tanvir Ahmed 

 

MA in Philosophy 

Jahangirnagar University, Savar, Dhaka-1342, Bangladesh.  

Email: tanvir92ju@gmail.com 

 

DOI: https://doi.org/10.3329/bioethics.v12i1.51900   

 

Abstract: The objective of this article is to establish an alternative doctor-patient relationship model 

and describe its importance in the case of the doctor-patient relationship in Bangladesh. There is a lot 

of diversity in the religious beliefs, social norms and values in Bangladesh. Likewise, the development 

of biological science as well as medical technology, the allocation of healthcare resources must be 

considered as an important issue. That is why the autonomy of both doctor and patient is a relational 

factor here. Besides, the four traditional doctor-patient relationship models offered by Ezekiel J. 

Emanuel and Linda L. Emanuel are not beyond criticism. So, we need an ideal doctor-patient 

relationship model for Bangladesh to protect every patient’s autonomy which will give freedom to the 

patient in choosing their own treatment as well as which will not conflict with the patient’s social or 

cultural values. In this article, I have selected the relational model of autonomy as the method of 

alternative doctor-patient relationship model. Hopefully, this alternative model will work better since it 

considers care first concerning a patient’s autonomy. Besides, doctors would treat their patients as a 

‘care seeker’ rather than ‘client’ or ‘customer’, and simultaneously, patients would perceive their 

physicians as ‘caregivers’. But, applying the relational model of autonomy in the case of doctor-patient 

relationship is more challenging in Bangladesh due to some obstacles like large numbers of population, 

illiteracy, insufficiency of skilled doctors and hospitals, corruption in medical sectors, social prejudices 

and so on. But, if we can overcome these problems, the relational model of autonomy will be considered 

as a suitable doctor-patient relationship model in Bangladesh. 

 

Key words: Care ethics, Doctor-patient relationship, Relational autonomy, Religious and social values, 

Medical ethics, Bangladesh.     

 

(Some part of this article was presented at 20th Asian Bioethics Conference, Dhaka, 

Bangladesh as Poster Presentation). 

 

Introduction: The doctor-patient 

relationship is an important issue in medical 

ethics. Since ancient times, all medical 

codes and guidelines were concerned to 

identify the basic principles of an ideal 

doctor-patient relationship. But there is no 

ideal model that is applicable to all cultures 

and all societies. The development of 

biological as well as medical sciences, 

medical technology, moral thinking, and 

social values, should be taken into 

consideration when we analyze any such 

relationship. In the last century, scholars 

have proposed various models for the 

doctor-patient relationship. The most 

accepted model is offered by Ezekiel J. 

Emanuel and Linda L. Emanuel. They 

mentioned four models of doctor-patient 

relationship in their article “Four Models of 

the Physician-Patient Relationship”1. 



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According to Emanuel and Emanuel, these 

four models are: i. The Paternalistic Model, 

ii. The Informative Model, iii. The 

Interpretive Model and iv. The Deliberative 

Model. Emanuel and Emanuel’s views are 

accepted and used in western well-ordered 

societies or developed countries2. But, 

these models are not suitable for all 

countries of the world due to social, 

cultural, religious and economic 

differences. All of these models, any single 

model is not appropriate for the 

Bangladeshi context. Paternalistic model 

exists in our practices of medical ethics2 

though it has some merits too during 

emergency treatment1. But, we reject it 

because this model violates the patient’s 

freedom, respect as well as autonomy. We 

can consider informed consent as a better 

model than paternalism. But it is not 

applicable because of the number of 

illiterate patients, insufficiency of trained 

doctors. Besides, in the interpretive model, 

the relationship of doctor-patient is 

maintained in a value hierarchy which 

contains two rival agents: superior and 

inferior. In that model, a doctor has got a 

superior position where the patient is 

treated as inferior. Thus, we consider the 

interpretive model as inappropriate for 

Bangladesh. Finally, the deliberative model 

is also inappropriate because this model 

would not be compatible with the socio-

economic and cultural pattern of 

Bangladesh. Therefore, we need an 

alternative practice of medical ethics in 

Bangladesh that will be suitable for our 

society and culture. As Bangladesh has a 

large population with different cultures and 

beliefs, it is difficult to ensure every 

patient’s autonomy. The conception of 

autonomy in Bangladeshi people’s beliefs 

and culture is relational. So, I argue for a 

richer conception of autonomy, especially 

‘Relational Autonomy’ for the practices of 

medical ethics in Bangladesh. The next 

section will introduce us to relational 

autonomy shortly. 

 

Relational Autonomy: Relational 

accounts of autonomy have been 

substantially developed by feminist 

philosophers. This conception comes from 

the idea of care ethics where the caring 

issue is regarded as more important in 

medical ethics as well as in bioethics. To 

give a clear notion about relational 

autonomy, we need to know the 

characteristics of care ethics. 

 

The care ethics esteems ‘care’ as the prime 

basis of morality and rejects the thought of 

‘fairness’ in moral thinking. Care ethicists 

feature some human characteristics, for 

example, care, sympathy, empathy, 

compassion, relations, which are more 

familiar with the feminine gender. The care 

ethics begins from the feminist approach of 

morality. Carol Gilligan first worked on the 

development of care ethics in her book In a 

Different Voice (1982). Later, this 

conception of care ethics is expanded by 

some other feminist philosophers like Nel 

Noddings and Van den Hoven. Gilligan’s 

works give us a positive interpretation by 

reconstructing traditional negative 

understanding of care related to women and 

acknowledge care as an ethically important 

thought. In Gilligan’s view, women are 

more caring to maintain relationships 

whereas men are concerned about “moral 

rules and justice”3.  

 

The term ‘relational autonomy’ does not 

refer to a single synthesized conception of 

autonomy but is rather an umbrella term, 

designating a range of related viewpoints4. 

It refers to an idea of autonomy grounded 



                                                                                         Bangladesh Journal of Bioethics 2021;12 (1):14-24 

 

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on the social nature of people’s lives. From 

these perspectives, people are intrinsically 

connected with a social environment 

marked by economics, politics, ethnicity, 

gender, culture, and so on. Besides, their 

profile is framed and formed by their social 

environment, just as their experience of 

embodiment, associations with others, and 

opportunities for a decent life. 

 

The supporters of ‘relational autonomy’ 

specifically have contended that people’s 

identities, needs, interests, and indeed 

autonomy are in every case additionally 

molded by their relations to other people. 

Not independence, but interdependence, is 

the core of the relational idea of autonomy. 

Social environmental factors and 

connections enable us to flourish and 

develop a robust capacity for self-

determination and identity formation5. 

Relational autonomy can be considered as a 

conception of autonomy that puts the 

person in a socially inserted organization of 

others. Relationships (with family, 

community and society), responsibility, 

care and interdependence are the key 

components of relational autonomy. 

Individuals build up their self-appreciation 

and form capacities and life plans through 

the connections they develop on a day and 

long-term basis. Therefore, relational 

autonomy states that social surroundings 

and relationships are essential for 

developing autonomy, and encourages us to 

act in manners guided by an ethic of trust 

and care6. 

 

In medical ethics, the relational model of 

autonomy is the most popular model to 

protect a patient’s autonomy nowadays. In 

health care, respect for autonomy 

emphasizes in particular the patient’s 

freedom of choice, specifically over what 

happens to his/her body. In medical issues, 

all patients are fundamentally connected 

with a social environment marked by 

economics, religion, politics, ethnicity, 

gender, culture, and so on. That is why 

every patient’s autonomy is different. So, a 

Patient’s autonomy can be protected by 

applying relational model of autonomy in 

the case of medical ethics such as patient-

centered care, doctor-patient relationship 

and so on. 

 

Suitability of Relational Autonomy in 

Doctor-Patient Relationship in 

Bangladesh: There are so many reasons 

why the relational model of autonomy is 

suitable for a developing country like 

Bangladesh. I will figure out some reasons 

and argue that relational autonomy is more 

suitable than any other doctor-patient 

relationship model. Some reasons are given 

below: 

 

Bangladesh is a poor country with a huge 

population. The financial position of each 

person is different. Everyone’s type of 

autonomy is not the same. People of 

different levels of society have different 

sorts of autonomy. If we give the same 

medical care to everyone, then it will not be 

able to protect everyone’s autonomy. The 

autonomy of people of the upper level of 

the society is not applicable to the lower 

level people of the society. Many people are 

involved in many issues such as individual 

belief, ritual, religion, culture, etc. in the 

field of autonomy. The doctors of our 

country do not treat all patients in the same 

way. The attitude of doctors is paternalistic. 

This paternalistic behavior of doctors is 

most commonly seen in the treatment of 

poor patients. Relational models of 

autonomy can be shown in different ways 



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to treat all patients from different economic 

classes and protect everyone’s autonomy. 

 

Constraint Factors: Religious Belief and 

Social Values: An important aspect of 

Bangladesh is that people of different 

religions live here. Most of the population 

is Muslim (88%) while a considerable 

number of citizens are Hindus (10%), 

Christians (1%), and Buddhists (1%). Here 

also live various ethnic entities and those 

who have different cultures and beliefs. 

Every person from every religion has 

different rituals and beliefs. In medical 

treatment, doctors should consider that. If 

the treatment policy contradicts the 

patient’s religious beliefs, that will violate 

the patient’s autonomy. Some cases like 

abortion, organ transportation, receiving 

blood from others and so on may create 

some critical conditions. 

 

For instance, one of the most popular cases 

in Bangladesh is the abortion case. 

Although abortion is legally prohibited in 

Bangladesh, abortion may be justified if 

there is a risk of death for the newborn and 

the pregnant mother. Besides, most 

Muslims does not support abortion because 

of their belief. Conservative Muslims never 

support abortion because it is prohibited in 

Islam. According to Islam, every life is 

sacred and as a fetus is a living entity, we 

have no right to kill a fetus and ruin its 

sanctity. But in recent times some liberal 

Muslims support abortion. Islam has a 

different view of the life of a pregnant 

woman is threatened. For example, if a 

woman is at risk of cancer or any other 

incurable disease due to pregnancy, or if 

there is a risk of death in childbirth, and if 

the matter is directed by a neutral and 

experienced doctor, then abortion before 

the age of four months is legal according to 

Islam7. Conversely, sometimes abortion 

becomes urgent to save the mother’s life 

but the Muslim mother does not want it as 

she believes her religion. In that situation, 

abortion will not be supported. So, in these 

cases, doctors should know the patient’s 

opinion to support the patient’s freedom as 

well as to protect the patient’s autonomy. 

Sometimes, many Muslim families do not 

support abortion but the woman who is 

pregnant supports it. So, in this case, the 

woman’s opinion should get priority. 

 

Now let us come to the context of Hindus. 

Traditional religions have different beliefs 

about abortion, rules and regulations that 

Hindus follow. Abortion is not supported in 

any way in the traditional Hindu scriptures. 

According to the Hindu religion, killing a 

fetus through abortion is equivalent to 

killing a priest. Even a woman who kills a 

fetus through abortion seems to destroy her 

offspring8. That is, in Hindu religious 

culture, abortion has been identified as an 

extremely reprehensible act. The Rigveda 

says, “Vishnu himself is the guardian of the 

future newborn” (Rigveda 6, 36: 9). That is, 

Vishnu himself has taken the responsibility 

for the life and death of the fetus. In that 

case, killing the fetus during pregnancy 

would be a great sin. Again, in the 

Shatapatha Brahmana, it is said, “The 

woman who has removed the fetus from her 

body has undoubtedly committed a great 

sin” (Shatapatha Brahmana 3: 1.2.2.1). An 

analysis of these scriptural statements 

shows that abortion is not supported in any 

way in the traditional Hindu scriptures. 

Liberal Hindu scholars, however, support 

abortion in the interest of saving the lives of 

pregnant mothers and newborns. 

 

Christianity also opposes abortion. To 

Christians, human life is sacred and a gift 



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from God that is said to be respected and 

protected. This teaching is called the 

holiness of life. The Bible teaches that man 

was created in the image of God and also 

teaches that killing is forbidden. Jesus 

reminded his followers that every living 

thing is precious to God. Considering that, 

the killing of fetuses is also prohibited. In 

the case of a woman’s pregnancy, the first 

fetal performance according to Christianity 

is a time when the mother feels the 

movement of the first fetus. According to 

ancient Catholic theology, the soul is 

received during the first fetus. According to 

Christian doctrine, the ‘soul’ is a boundary 

that separates non-human beings from 

human beings9. So it is wrong to kill an 

embryo in the womb. However, some 

liberal Christian theologians believe that 

abortion can be supported if the pregnant 

mother and child are at risk of death. Thus, 

there are differences of opinion among 

Christians regarding abortion, which also 

applies to the Christian citizens of 

Bangladesh. 

 

The moral problem of abortion is also 

created in Buddhism. Buddhism does not 

support ‘killing living beings’ like abortion. 

Buddhists believe that no life should be 

neglected or deliberately killed. Buddhism 

does not support abortion because life is 

deliberately killed here. However, there is a 

crisis in Buddhism when pregnant mothers 

and children are at risk of death. Because, if 

abortion is to be accomplished to save a 

pregnant woman, it will conflict with 

Buddhism. Therefore, in such a crisis, 

different decisions may have to be taken.   

 

Another topic that is currently being 

discussed in the medical field of 

Bangladesh is organ transplantation which 

involves social and religious issues also. 

For example, most Muslims believe that 

Islam forbids organ donation. Muslims who 

oppose organ donation believe that since 

the Qur’an does not directly mention organ 

donation, organ donation is not acceptable 

in Islam. According to Islamic custom, the 

body of a dead person is to be buried as 

soon as possible after death. Therefore, the 

preservation of organs from the body of a 

dead person cannot be supported. Liberal 

Islamic thinkers, however, advocate saving 

lives through organ transplants because 

protecting human life is a virtuous act in 

Islam. 

 

Likewise, organ transplantation is 

supported in Hinduism. Organ donation is 

supported in Hindu scriptures because it 

saves the life of another human being and 

simultaneously, selfless donations (Daan) 

are considered as a pious act. In Hinduism, 

charity is the third of the ten virtuous deeds. 

Besides, the death afterlife is an ongoing 

process of rebirth in Hindu belief. This 

concept is seen as a positive reflection in 

organ donation and transplantation10.  

 

The main branches of Christianity, both 

Catholic and Protestant, support and 

encourage transplantation. Christians 

consider organ donation to be an act of love 

and a way to follow Jesus' example11. 

Again, organ donation and transplantation 

are not supported in Buddhism. According 

to Buddhist culture, corpses have to be kept 

intact with respect to nature and ancestors. 

Therefore, it is not justifiable to remove an 

organ from the body of a dead person 

before cremation after death12. 

 

There are some additional cases like some 

Buddhists deny taking vaccines for 

bacterial diseases. Because they believe 

that germs are also living entities and 



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according to their religious belief, killing a 

living entity is a sin. They give priority to 

the other living entity rather than their own 

life. In these cases, heavenly salvation is 

more important than saving one’s own life. 

So, the doctor should keep this in mind 

when he gives treatment to a Buddhist 

patient. 

 

Some gender-related issues are also 

involved in the medical policy of 

Bangladesh. There are many differences in 

diseases between men and women, and 

their treatment is different. But, in a male-

dominated society like Bangladesh, it is not 

considered properly. Most of the time, our 

society does not require the necessary 

attention to women, especially pregnant 

women. An adult girl needs special care and 

nutrition during her period. But, because of 

some prejudices, most of the time we are 

not concerned. In our society, after the 

marriage of a girl, she has to live with her 

husband, accommodating the new culture 

and ritual of her father in law’s house. So, 

in Bangladesh, girls are facing many 

obstacles where the men do not have to go 

through such problems. For that reason, the 

autonomy of man and woman is not the 

same in Bangladesh and the medical 

treatment is not the same, rather relational. 

In doctor-patient relationships, these sorts 

of gender-related issues should be 

considered. That is why relational 

autonomy is important to protect men’s and 

women’s different autonomy.  

 

From that discussion, we understand that in 

the case of doctor-patient relationship in 

Bangladesh, considering every patient’s 

religious beliefs and social issues are very 

important. Because, in maximum cases, the 

patient’s value and the doctor’s value may 

not be the same. Doctor value may be 

saving a patient’s life; conversely, a 

patient’s value may be heavenly salvation 

following his/her own religious or cultural 

beliefs. Doctors have no right to hit a 

patient’s belief and social value. Everything 

is a related issue in treatment. When a 

patient’s religious beliefs and social values 

are considered, then the patient’s autonomy 

will be protected. Thus, we may claim that 

relational models of autonomy can play a 

vital role in Bangladesh content. 

 

Constraint Factors: Patient’s Economic 

and Geographical Differences: 

Bangladesh is a very poor country and 

People are engaged in different 

occupations. All classes of people including 

the rich, middle class, and poor people are 

here. So it is not possible to afford the 

treatment costs of all people equally. So, 

everyone’s autonomy is not the same here. 

For example, in the case of high-cost 

medical treatment, rich or middle-class 

patients can sustain it but poor patients 

cannot. Sometimes, for the poor patient, 

running the family cost is more important 

than their medical treatment. In such cases, 

doctors should inform patients about their 

treatment costs. Also, there are differences 

between the physical condition and 

treatment of urban people and rural people. 

The eating habits of people in all the 

districts of our country are not the same. 

There is also a difference between the food 

and nutrition of the people of the different 

regions. In those districts where natural 

disasters are high, people of these areas 

suffer from malnutrition and diseases. It is 

especially seen in the northern districts of 

Bangladesh. Most of the northern districts 

of Bangladesh are poor and the children are 

deprived of necessary vaccinations after 

birth. Most of the children in the village 

grow up in an unsavory environment. So, 



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the medical services of the people of the 

city will not be the same as the medical 

services of those rural area people. Here, 

geo-cultural identity is an important part 

that must be considered in medical policy. 

Considering the geographical, economic 

and environmental aspects of different 

people in each region of Bangladesh, 

healthcare will be equally balanced. So, we 

may say that economic and geographical 

issues should be considered as a relational 

issue in medical policy like doctor-patient 

relationship in Bangladesh. Here, the 

relational model of autonomy can ensure 

the autonomy of people by treating people 

in one area with their medical needs. 

 

The Benefits of Relational Autonomy in 

Doctor-Patient Relationship: When we 

get benefits from the applications of 

relational autonomy, then we will realize 

why the Relational model of Autonomy is 

so important for Bangladesh in the context 

of doctor-patient relationship. Now, this 

section will emphasize the benefits of 

relational autonomy. The benefits that will 

be the most in doctor-patient relationship in 

Bangladesh are given below: 

 

Firstly, the paternalistic approach will be 

reduced. The patients will get the freedom 

to express their own opinion about diseases 

and the doctors cannot impose any 

treatment on the patients. Therefore, the 

patient will be informed about their medical 

treatment and hence the patient’s autonomy 

will be protected.  

 

Secondly, a patient’s religious beliefs and 

social values are not violated. In the 

relational model of autonomy, a particular 

patient’s religious beliefs and social values 

are considered by the doctor. 

 

Thirdly, there will be no class 

discrimination between doctor and patient 

where paternalistic model builds class 

discrimination between doctor and patient 

creating superior position for the doctor and 

treats the patient as inferior. In the 

paternalistic model, patients are dominated 

by the doctor whence in relational model of 

autonomy, patients get proper freedom. 

 

Fourthly, there will be a strong relationship 

constructed between the doctor and the 

patient. In relational model of autonomy, 

patients are informed about their own 

diseases. For this reason, patients get an 

idea about their diseases and treatment. 

Hence, the patient gets the confidence of 

the doctor’s advice. Because, next time, the 

patients will be more careful about their 

health and diseases. Consequently, this 

built up a positive relationship between 

doctor and patient. 

 

Fifthly, the apprehensiveness of the patient 

may get relieved and the confidence will be 

reached. Patients will be psychologically 

strong when they will be informed about 

their health condition and get the freedom 

to choose their own treatment which is 

suitable.  

 

Sixthly, corruption in medical treatment 

will be reduced. Corruption in the medical 

field is a common instance in Bangladesh. 

Paternalistic approach cannot remove this 

corruption because patients are treated here 

as a client or a customer. But, the relational 

model of autonomy will consider all 

patients as a care seeker and make the 

doctor a caregiver. As a result, care ethics 

will be established instead of professional 

attitudes and there will be no corruption 

here.  

 



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Seventhly, People in Bangladesh will rely 

on the medical services of the country. 

Because maximum people have no reliance 

on the treatment policy of Bangladesh. 

Paternalistic approach is one of the reasons 

for this attitude. Thereby, people go to 

inexperienced doctors and take the wrong 

treatment. Relational model of autonomy 

can increase the reliance on Bangladeshi 

medical treatment policy.  

 

Challenges of Applying Relational 

Autonomy: When we apply the relational 

model of autonomy in the case of doctor-

patient relationship in Bangladesh, it will 

be very challenging. We have to face many 

types of obstacles. This section will focus 

on the challenges of applying relational 

autonomy.  

 

Firstly, Population is the first major 

obstacle. Bangladesh is a small country 

with a large number of populations. 

According to the report of Bangladesh 

Statistics 2019, there are 85,633 registered 

physicians, 8,130 registered dental 

surgeons and 48,001 registered diploma 

nurses in Bangladesh for the whole 

population of 164.6 Million13. As indicated 

by these statistics on physicians who were 

registered with BMDC (Bangladesh 

Medical and Dental Council), there is only 

one physician per 1,847 people14. 

Necessarily, these data show a very poor 

doctor-patient ratio and have a significant 

impact on the doctor-patient relationship. 

For this reason, the doctor-patient 

relationship is rather complex in 

Bangladesh because doctors claim that it is 

not possible to maintain an ideal 

relationship with patients since they have to 

provide services for a gigantic populace 

inside a restricted period. Managing an 

excessive number of patients and the 

pervasiveness of conflict of interest have 

serious negative outcomes. In some cases, 

one can even doubt whether a doctor-

patient relationship is actually present in 

treatment decisions. Now, the question may 

be raised about where the patient does not 

receive medical treatment properly, and 

then how we can protect everyone’s 

autonomy. 

 

Secondly, illiteracy plays as a major 

obstacle in establishing relational 

autonomy. Most of the people of our 

country are illiterate and they have no idea 

about medical treatment. Thus, discussing 

about their diseases and treatments is quite 

impossible. At the same time, each patient 

should be aware of their respective 

religious beliefs and social values which 

they will share with the doctors. In most 

cases, many patients are not aware of their 

own religion. In these cases, the guardians 

of patients assist in giving informed 

consent. But, this process does not establish 

the patient’s own autonomy and this may 

turn into another form of paternalism. If the 

patient is illiterate, communication between 

the doctor and the patient is interrupted and 

the doctor is obliged to provide medical 

care which s/he thinks better. So, in this 

case, autonomy will not be established, and 

as a result, it will turn into paternalism. So, 

the main factor is that if we establish 

relational autonomy in doctor-patient 

relationships to ensure every patient’s 

autonomy, everyone must be educated at 

least.  

 

Thirdly, language is an important medium 

to establish relational autonomy 

successfully in doctor-patient relationships. 

If the doctor and the patient do not 

understand each other’s language, then 

proper communication between them is not 



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possible. Doctors have to study in English 

and the language of medical science is very 

complex which patients cannot understand 

properly. The doctor also needs to 

understand the language that the patient 

will speak. As most of the people of 

Bangladesh are illiterate, the lack of proper 

use of language will be a big obstacle in 

establishing relational autonomy. The 

people of most districts of Bangladesh 

speak regional languages and they name 

various diseases in regional terms that may 

be unknown to the doctor. As a result, the 

doctors will not comprehend the patient’s 

religious and social values properly and the 

kind of medical care they provide to the 

patient may not be properly reported to the 

patient. Then the patient’s autonomy in the 

medical service will not be established 

securely. So, in these types of cases, doctors 

should know the use of people’s language 

in different regions. Then relational 

autonomy will only get success.  

 

Fourthly, doctors should be highly educated 

and have to be experts on various diseases. 

The skilled and specialist doctors who are 

in Bangladesh are mainly providing 

medical services to the capital Dhaka and 

divisional cities. In rural areas, there are 

few experts and skilled doctors. There are 

also many quack and fake doctors in the 

country. So people of all classes will not get 

equal treatment when they go to different 

classes of doctors. Besides, if the doctors 

want to understand the religious and social 

values of their patients, then they will have 

to study it. In addition to medical science, 

doctors should keep in mind the notion of 

different branches of knowledge like 

history, religion, anthropology, social 

science and so on. But sometimes the 

doctors do not have the proper skills in 

these areas. Therefore, to ensure patient’s 

autonomy, the doctor has to be proficient in 

his own field.  

 

Fifthly, another major obstacle is the 

insufficiency of the allocation of healthcare 

resources. The allocation of healthcare 

resources includes distributing health-

related materials and services among 

various uses and people. The medical 

resources that are used in the Dhaka city 

hospital are not available in the hospitals of 

other districts outside Dhaka. As a result, 

discrimination creates in providing services 

to patients in different areas of hospitals. 

Consequently, both medical treatment and 

the autonomy of the patient are hampered. 

So, ensuring the allocation of healthcare 

resources in every hospital in Bangladesh is 

very important to establish relational 

autonomy in doctor-patient relationships in 

Bangladesh.  

 

Sixthly, in emergencies when the patients 

are about to die or in a coma, this is 

impossible to get information about the 

patient. In these situations, a patient’s life is 

more important than protecting the 

patient’s autonomy to the doctors. For 

example, there are many road accidents that 

occur in Bangladesh every day where the 

identity of the victims is unknown. In this 

situation, doctors should give priority to 

protect patient’s lives. Here, the doctor’s 

value is protecting the patient’s life and the 

doctor will decide what sort of treatment 

will be best for the emergency patients. In 

this case, paternalism is more acceptable 

than relational autonomy. So, we have to 

keep these points in mind. 

 

Seventhly, the doctor’s role in Bangladesh 

is multidimensional. A senior doctor 

simultaneously is an instructor in clinical 

school and a chief of the hospital as well as 



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23 
 

a private consultant. Most of the doctors 

work as a clinical officer and private 

practitioner. Besides, doctors work in 

diagnostic centers or get commissions from 

them, subsequently, they have contending 

interests. Obliquely, Doctors help 

pharmaceutical companies to market their 

medicine prescribing their medicine to the 

patients and get some percentage of the 

expense from the companies15,16. These 

types of issues impact the patient-physician 

relationship and this indiscipline in the 

medical sector will also create problems to 

establish relational autonomy. 

 

Above the discussion, we found that a lot of 

obstacles will be faced to establish 

relational autonomy in the case of doctor-

patient relationship in Bangladesh. It is a 

very challenging issue. But, with a view to 

accepting these challenges, we need to 

develop some issues to tackle these 

obstacles. The steps that will be taken in 

this regard are discussed below:  

 

First of all, we need to give proper training 

to the doctors and the number of doctors has 

to be increased. The huge population may 

seem to be a big obstacle to us but this will 

not be a big obstacle for us if we can make 

adequate skilled and specialist doctors. In 

implementing this, the government will 

have to increase the budget in the medical 

sector. At the same time, adequate hospitals 

and health complexes should be built in the 

city and village areas. Besides, the 

allocation of healthcare resources should be 

ensured in every hospital.  

 

In Bangladesh, the rate of education should 

be increased and everyone must have 

correct ideas about their social and religious 

values. At the same time, the doctors also 

have the correct ideas about the religious 

and social issues of the people living in 

Bangladesh. Besides, the government will 

have to pay attention to the corruption in the 

medical field. The relational model of 

autonomy in doctor-patient relationships 

will never be established unless corruption 

is suppressed in the medical sectors. 

Because, if the relational model of 

autonomy is established and 

simultaneously, the medical sector is 

corrupted, the medical policy will be 

paternalistic again. 

 

Conclusion: This article shows how to 

reduce paternalistic approach in the 

medical sector in Bangladesh and build up 

an appropriate doctor-patient relationship 

model that may protect every patient’s 

autonomy considering all religious, 

cultural, economic and geographical 

circumstances. This alternative model will 

give freedom to the patient in choosing 

their own treatment as well as which will 

not conflict with the patient’s social or 

cultural values. For this purpose, I have 

used the relational model of autonomy in 

this article as a suitable model in the case of 

doctor-patient relationship. In this regard, I 

have discussed different religious, social, 

cultural values which exist in the belief of 

people living in Bangladesh. Most of the 

people in our country are Muslims. We 

found that various medical issues such as 

abortion, organ transplantation etc. exist 

here. Sometimes, Islamic religious values 

contradict medical policy. The same 

happens to Hindus, Christians and 

Buddhists. If a doctor’s values contradict a 

patient’s social or cultural values, the 

patient’s autonomy will be violated. 

Because, sometimes a patient’s heavenly 

salvation is more important while for a 

doctor, saving a patient’s life is more 

important. As we found that relational 



                                                                                         Bangladesh Journal of Bioethics 2021;12 (1):14-24 

 

24 
 

autonomy considers a patient’s cultural and 

social value, it is more appropriate for 

Bangladesh in the case of doctor-patient 

relationship. But, applying relational model 

in doctor-patient relationship is more 

challenging in Bangladesh due to some 

obstacles like large numbers of population, 

illiteracy, insufficiency of skilled doctors 

and hospitals, corruption in medical 

sectors, social prejudices and so on. But, if 

we can overcome these problems, relational 

model of autonomy will be considered as a 

suitable doctor-patient relationship model 

in Bangladesh.  

 

Acknowledgments: This paper is the part of my 

Master’s thesis. I deeply acknowledge the 

suggestions that I received from my Master’s thesis 

supervisor, A S M Anwarullah Bhuiyan, PhD 

Professor, Department of Philosophy, Jahangirnagar 

University. I am very much thankful to him. 

 

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Author contribution: I conceived the idea, did the 

literature review, wrote the manuscript and checked 

the manuscript meticulously.  

 

Conflict of interests: There is no conflict of 

interest.  

 

 

 


