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Updated: Apr 20, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
[Who is the decision maker in medicine - the doctor or the patient?]
Johann Steurer1, Maria Wertli1
1Horten Zentrum für praxisorientierte Forschung und Wissenstransfer, Universität Zürich.
Insights
Physicians now involve patients in healthcare decisions, shifting from paternalistic to participative models. Patients have a right to be informed but can also opt out of certain information.
Area of Science:
- Medical Ethics
- Health Communication
Context:
- Historically, physician-led decision-making (paternalistic model) dominated healthcare.
- Contemporary healthcare emphasizes patient autonomy and active involvement in treatment choices.
Purpose:
- To explore the evolution of patient involvement in medical decision-making.
- To contrast the paternalistic and participative (shared decision-making) models.
Summary:
- The shift from paternalistic to participative models involves informing patients about their health status and treatment options.
- Shared decision-making empowers patients, but respects their right to not be informed if they choose.
Impact:
- Promotes patient-centered care and enhances patient autonomy.
- Highlights the nuanced balance between transparency and a patient's right to privacy regarding health information.
Abstract:
In earlier times physicians decided on their own which diagnostic tests and treatments the patient should undergo, receive and follow. At least, such physicians' behavior is described in the literature. In recent decades the pendulum moved in the other direction. Nowadays and deservedly so patients have to be actively involved in the process of decision-making. The old fashioned method of decision-making is called the paternalistic model and the modern one the participative model (shared decision making). A prerequisite for being actively involved in the decision process patients have to be informed about their health status and the consequences of different options and potential decisions. There is no plausible reason to question the values of the participative model, but patients also have a right to be not informed about things they do not want to know. Transparency is desirable, but transparency is not 'per se' a good thing only.
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