A defence of medical paternalism: maximising patients' autonomy

All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper.After reviewing philosophical interpretations of autonomy and paternalism, the author considers these principles in the context of the physician-patient relationship. He concludes that, since illness entails a state of diminished autonomy, a limited form of medical paternalism--aimed at maximizing the patient's autonomy--is justified.