Patient-Physician Relationship: The Effects of Autonomy and Paternalism

Introduction

The practice of medicine in general has changed due to changes in technology, economics, epidemiology, and demographics. But particularly, the patient-physician relationship has been transformed during the past century, from one characterized by strong physician paternalism to one that reflects strong patient autonomy. (1)

Medical ethics in general is not a modern term; it goes back in time to the 12th century to the Hippocratic Oath. Recently in the 21st century the interest in medical ethics was provoked by a series of medical scandals: Nazi medical experiments, the infamous Tuskegee syphilis studies and so on. After which autonomy in the form of an informed consent was obligatory for minor and major procedures. (2, 3)

What is Autonomy?

Patients’ autonomy is the respect for the decision-making capacity of competent adults. This has now been fully integrated into the practice of medicine. This ‘patient’s right’ to accept or refuse medical care changed the balance of power in the patient-physician relationship and engaged the patient more in ownership of care plans and it is viewed by patient and physician, essential for honoring the individual and his or her dignity. (4)

The effect of autonomy & paternalism:-

Both autonomy and paternalism and their effect on patient –physician relationship evolved over time due to their advantages and disadvantages which can be summarized as following:-

The previous mastering of paternalism in decision making had the advantage of physician being the one to struggle in choosing the best treatment for the patient without burdening the patient or his family with decision making. But excessive paternalism, or over-influence of physician, had disadvantages: as deprivat...

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