Patient-Physician Relationship: The Effects of Autonomy and Paternalism

INTRODUCTION Medical practices have changed due to changes in technology, economics, epidemiology and demographic. However, particularly during the past century, the relationship between patients and physicians changed from features characterized by the strong doctor's parent's style to those that reflect strong patient autonomy. (1) Medical ethics is not a modern term in general, it dates back to the 12th century and dates back to Hippocrats. Recently in the 21st century, interest in medical ethics was caused by a series of medical scandals: Nazi medical examination, notorious Tuskegee syphilis research.

In biomedical ethics, the concept of patient autonomy is a major consideration. This autonomy is in stark contrast to the so-called medical parent's style. A medical parent's style is to act on behalf of doctors thinking that they are most suitable for them regardless of the patient's real desire. This is an intervention to the right to take personal actions for reasons related to personal welfare and interests. Parental medical styles may be considered positive, but many people dispute it. In Goldman 's paper "Rebuttal of Parent Medical Style", he talked about why the parent' s medical style is wrong.

In recent decades, relationships between patients and doctors have developed, one of which is a fatheristic doctor, and doctors make decisions based on their professional value. Letting adult patients make their own choices is called "informed consent". Informed consent has four important elements: disclosure, ability, understanding, and volunteer.

In the past 40 years, the principle of autonomy, the right to make decisions in its own way has transcended the parent's style. From patriarchal to autonomous, power and control are transferred from the doctor to the patient. Currently there are federal laws over 20 years, including making decisions about patients, refusing treatment and protecting the rights others might think. It is not their best interest. It asks the healthcare provider to follow the patient's prior instructions including the desire to not revive. However, many studies indicate that healthcare practitioners often ignore prescribing prescriptions, especially if they conflict with the values ​​and beliefs of individual healthcare professionals in charge of treatment .

A serious disregard for the patient's autonomy becoming more and more dominant is the effect of the doctor on autonomy. As with other moral relationships, relationships between physicians and patients are also interrelated. Paying reasonable attention to patient autonomy tends to forget that a doctor is an ethical actor and a patient. Therefore, physician autonomy and patient autonomy deserve respect. When two conflict, the patient 's request automatically does not surpass the doctor. Like a patient, physician autonomy has a negative and positive structure