A Brief Historical and Theoretical Perspective on Patient Autonomy & Medical Decision Making - Part I: The Beneficence Model
CHEST 139 (3), March 2011
5 Pages Posted: 29 Aug 2012 Last revised: 15 Dec 2015
Date Written: March 1, 2011
The practice of medicine today looks very different than it did 2,500 years ago, though interestingly, there has been greater change in the last 100 years or so than in the previous 2,400. As part of a larger series addressing the intersection of law and medicine, this essay is the first of two introductory pieces, and it will explore the nature of the physician-patient relationship and of the practice of medicine dating from the Hippocratic Tradition to the end of the 19th century, a period during which a beneficence-based medical ethic remained relatively stable.
The shift from the Beneficence Model (characterized by maximum physician discretion) to the Autonomy Model (emphasizing increased patient involvement) paved the way for a new approach to decision-making in medicine governed legally by informed consent doctrine. The medical literature dating from the Hippocratic texts to the early codes of the American Medical Association did not include a meaningful role for the patient in the decision-making process. In fact, the practice of benevolent deception was encouraged – deliberating withholding any information thought by the physician to be detrimental to the patient’s prognosis. As philosophers identified an inherent value in respecting patient self-determination and the law imposed a duty on physicians to obtain informed consent, 2,400 years of relative stability under the Beneficence Model gave way to the Autonomy Model.
Keywords: Law, Bioethics, Autonomy, Medical Decision Making
Suggested Citation: Suggested Citation