Deficits versus strengths: Ethics and implications for clinical practice and research

A shift in emphasis from deficits to strengths to promote health and wellbe ing in patients with congenital and acquired craniofacial conditions (CFC) is appropriate given the chronic, "incurable" nature of CFC, Personal narra tives are a valuable starting point for discovering sources of resilience. This paper explores such a shift by considering two areas of ethical concer n suggested by patient narratives: informed consent and the physician-patie nt relationship. Both areas contain pitfalls and opportunities. The powerful emotions these patients bring with them argue for caution in m edical decision making. Attention to the individual's psychosocial adjustme nt should always supplement surgical evaluations. Because of the inequality of the physician-patient relationship, care should be taken to use this po wer in positive ways. The relationship between patient and surgeon is parti cularly charged and may be an important source of support, information, hop e, and advice for patients. The changing health care system threatens the p hysician-patient relationship, but the rise of alternative medicine suggest s patients continue to value relationships. Relationships are critical for individuals with CFC, who experience social rejection because of the fundam ental importance of face in human interactions. Future research directions should include long-term outcome studies on pati ents receiving modern craniofacial team care, qualitative research on resil ience in patients with positive life adjustment, and development of a conce ptual framework and research methodology for understanding quality of life of individuals with CFC, An emphasis upon strengths rather than defects wil l have implications for the structure of craniofacial teams, the care that is provided, and allocation of resources.