Equal partners: doctors and patients explore the limits of autonomy

In recent decades medicine--like all social institutions--has fallen from public trust. Managed care has made third-party payers a partner in the physician-patient relationship. Advocate groups, some lawyers, and bioethicists have encouraged patients to demand a greater voice in medical decisions. Physicians and patients are forced to relate to each other in a narrower range, and more of the physician's actions are being dictated and standardized. Physicians are often seen as a threat to the patient's autonomy and believed to be too paternalistic, authoritarian, and too concerned with profit to be reliable partners. A review and synthesis of the literature supports the view that patients prefer to have decisional control over outcomes but leave technical decisions on how to achieve those outcomes to physicians. Good medical care is a process of having one's autonomy respected and knowing when to relinquish it. Promoting patient autonomy as an ultimate value in medicine rather than recognizing it as one value among others (such as caring, trust, and honesty) is an error. The task of medicine is not to banish paternalism, but to preserve kindness and respect for the patient as a person.