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 deprivation of the patient from the opportunity to make decisions that reflect the reality of their conditions; inappropriate biases were caused by sex, race, and socioeconomic status that affected decision making; and it didn’t take into account patients’ best interests. (5-7)
From there came the importance of autonomy in preventing inappropriate paternalism and unwanted interventions that may burden the patients more than benefiting them, and on the other side of the line, involve the patients more in their health care. (8)
Involving patients in decision making is not just about offering and allowing choice, but also enabling informed decision-making. And not the wrong idea, that respecting autonomy means obliging clinicians to tell patients about health care options then stand back and abide by their choices. (9)
The degree of autonomy differs from one person to another also in the same person from one time to another, due to a number of factors that affect a person’s autonomy including: health conditions, treatment, knowledge, experience and skills, personal approach as well as familial patterns, type of relationship, life history and social context. (10)
So if the physician’s focus was mainly on decision-making,...