The Golden Rule vs. the Platinum Rule in a Healthcare Setting

The Golden Rule teaches that I should do unto others as I would have them do unto me. That sounds great — but when we dig a bit beneath the surface, it’s apparent that the Golden Rule can be problematic. Treating someone else the way I want to be treated or am willing to be treated may not align with that individual’s views of what is right or good.  

For example: Suppose I’m someone who’s very uncomfortable with the idea of getting older, and as a result, I don’t want anyone, even my family members or friends, to even mention my birthday. No cards, no cakes, no presents — nothing that serves as a reminder that another year has passed. Does it follow, then, that I should treat others’ birthdays the same way, no acknowledgment of any kind? After all, the Golden Rule says I should treat others the way I want to be treated . . .    

And that brings us to the Platinum Rule. 

The Platinum Rule calls on me to treat you with the consideration with which you would like to be treated. Whereas the Golden Rule is “me-focused,” the Platinum Rule is “you-focused.” The Platinum Rule requires me to think about you and what you need or want in order to feel cared for and appreciated, rather than about what I would need or want in order to feel cared for and appreciated in the same situation. It appropriately recognizes that you are the expert regarding what makes you feel valued and respected — and I am not. 

“Treat others the way they want to be treated,” which emphasizes empathy and individualized care, is especially important in a medical setting. Here’s an example:

Suppose that a patient (let’s call her Jeannie) — is newly diagnosed with a serious condition. She wants detailed information about the possible benefits as well as the potential burdens and risks of all of her treatment options — including non-treatment. She wants to be actively involved in making decisions about what she is willing to undergo. 

A healthcare provider following the Platinum Rule would, first and foremost, take the time to get to know Jeannie and understand what her preferences are when it comes to being informed and making decisions about her care. To do that, the healthcare provider would engage in active listening and ask clarifying questions. The healthcare provider would also give Jeannie comprehensive information about her condition and explain clearly all of her treatment — and non-treatment — options, so that Jeannie feels knowledgeable and capable. The healthcare provider would also make sure that Jeannie made her own medical decisions to the greatest extent possible, and that her decisions were respectfully and appropriately implemented. 

In contrast, a healthcare provider following the Golden Rule would base interactions with Jeannie on how they would want to be treated if they were in Jeannie’s situation. If the healthcare provider is the kind of person who doesn’t want a lot of information and likes to make quick decisions based on “instinct” or “intuition, then she would conduct her communications with Jeannie with those preferences in mind. The healthcare provider might give Jeannie a brief explanation of her condition and her treatment and non-treatment options to try to keep things simple. However, Jeannie might come away from that interaction feeling she didn’t receive as complete a picture of her situation as she wanted.  

When discussing Jeannie’s treatment options with her, the healthcare provider might encourage her patient to “trust her intuition” or “go with her gut.” If Jeannie is an analytical person, she might consider making a decision based on intuition or gut feelings to be irresponsible. The healthcare professional might press her patient for a quick decision, and if she hesitates, she might offer to make the decision for her. This could make Jeannie worry that the healthcare provider doesn’t think she’s capable of participating actively in her own care, making Jeannie (more) anxious and upset during what is already a very difficult time. When the healthcare provider uses her own preferences to influence her interactions with Jeannie, she is not providing her patient with the kind of care she needs and wants from members of her medical team. 

Instead, the healthcare provider should use the Platinum Rule as her guide, which will enable her to form a more effective therapeutic relationship with Jeannie and thus deliver what may be more effective medical care.  

Valentine’s season offers a great opportunity to think about the Platinum Rule, but to keep it shiny and bright, we should polish it daily by applying it in all of our interactions.

Lisa Goldman, Bioethicist in Residence