Granting Autonomy Is Not Sufficient – Patient Self-Determination Needs Active Support By Physicians

DOI: 10.3238/zfa.2014.0246-0250

german translation / full article

Jürgen in der Schmitten

Keywords: Patient Autonomy Patient Self-Determination Paternalism Informed Consent Shared Decision Making

Introduction: During the development of our jurisdiction, the patient right to self-determination has become widely established. However, what follows from the ideal of an autonomous choice for the relation between physician and patient?

Methods: Selective search and synthesis of papers from medical ethics, and health systems research.

Results: Paternalism, be it benevolent or not, is not regularly compatible with patient autonomy. A conceptional counter movement, the information model, fails to consider the neediness of many patients, and the significance of social interaction for the development of autonomous choices. Instead, the model of shared decision making (SDM) can be viewed as the optimal foundation for the realisation of patient autonomy. SDM presupposes an active role of the physician in the interaction, and an attitude that seeks to support the patient to arrive at a decision that is best within his or her individual set of values. The so-called “participative decision making” (a German adaptation of SDM), however, reveals neo-paternalistic traits when analysed closely.

Discussion: Far-reaching consequences derive from the recognition that autonomous patient choices need active promotion by physicians, at times implying a constructive-controversial debate: consequences for medical education, postgraduate training, and continual medical education; for our behaviour in day-to-day family practice, and for the formation of our health care system.

(State: 13.05.2015)

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