The Levels of Doctor-Patient Relationship - Analysis from the Kohlberg's Theory of Moral development

We propose to build a theoretical model regarding the doctor-patient relationship starting from the stadiality of moral development proposed by Kohlberg. He proposes an understanding of individual moral development as a gradual development of his moral conscience, starting from the heteronomous-autonomous distinction and implications of behaviour on moral conduct and on agent capacity. We don't agree with the author's opinion according to which the order of moral development stages is unvarying, as they are not covered by all people at the same age. We used a secondary analysis of data on the responses given in the interviews and focus groups held with patients with diabetes and their stakeholders, general practitioners caring for patients with diabetes and diabetes doctors. We used the analysis of discourse, in a process of open coding and axial coding. As results, we could identify patterns of doctor-patient relationships to match with the stages described by Kohlberg, pre-conventional morality, contractualist morality, autonomy, etc. Therefore, we constructed an array of patterns of doctor-patient relationship where the levels of moral development are understood as levels of social construction of autonomy. We consider that this approach can generate a communicational model between doctors and patients and improve the future therapeutic relationship. (C) 2013 The Authors. Published by Elsevier Ltd.