[Beyond the informed consent: the relationship consensual]

The current paradigm of medicine places the principle of self-determination at the centre of the system of treatment, as an essential condition for the validity of medical action, even from the ethical point of view. But if it is not correctly integrated with the former principle, that of doing good, the principle of self-determination alone cannot guarantee a fully ethical dimension in medical action, among other reasons because it would arrive at a contractual-type way of reasoning, in which the doctor's position would be subordinate to that of the patient. Only a situation where both sides are truly equal protagonists in the decision-making process, and both truly share the assumption of responsibility, can take full account of the centrality of the person in relation to his or her treatment. In this way the quality of the relationship, even from the ethical standpoint, would be the axis of the treatment paradigm, over and above, for instance, informed consent. The demands for euthanasia that could be derived from the application of the principle of self-determination need to be forestalled by a renewed discovery of the value of good in its double dimension: the subjective one of the perceived good, and the objective one of the moral good.