title: A brief historical and theoretical perspective on patient autonomy and medical decision making: Part I: The beneficence model.
abstract: As part of a larger series addressing the intersection of law and medicine, this essay is the first of two introductory pieces. This article explores 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 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--the deliberate withholding of any information thought by the physician to be detrimental to the patient's prognosis--was encouraged. However, 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.
authors.affiliation: Bioethics and Health Law Center, Mississippi College School of Law, Jackson, MS. Electronic address: will@mc.edu.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Will
mesh_terms: D000574:American Medical Association / Q000266:history; D003657:Decision Making / Q000941:ethics*; D003661:Decision Support Techniques; D004992:Ethics, Medical / Q000266:history*; D006625:Hippocratic Oath; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D010358:Patient Participation / Q000266:history; D028701:Patient Rights / Q000941:ethics / Q000266:history* / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations / Q000941:ethics; D010820:Physicians / Q000941:ethics / Q000331:legislation & jurisprudence; D011787:Quality of Health Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D014481:United States