title: Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.
abstract: BACKGROUND
  Patient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients' expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is currently undergoing this particular process.
  
  
  METHODS
  Qualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6(th)) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.
  
  
  CONCLUSIONS
  Patient autonomy is much more than a simple notion defined as the patient's right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.
  
  
  CONCLUSIONS
  Knowing how to respect the various facets of patients' autonomy should be part of physician's professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia.
authors.affiliation: Department of Educational Technology, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia. lmurgic@snz.hr.
authors.forename: Lucija
authors.initials: L
authors.lastname: Murgic
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada. philip.hebert@utoronto.ca.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hébert
authors.affiliation: Department of Medical Statistics, Epidemiology and Medical Informatics, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia. ssovic@snz.hr.
authors.forename: Slavica
authors.initials: S
authors.lastname: Sovic
authors.affiliation: Department for Social Medicine and Organization of Health Care, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia. gpavleko@snz.hr.
authors.forename: Gordana
authors.initials: G
authors.lastname: Pavlekovic
mesh_terms: D003219:Confidentiality; D017523:Croatia / Q000453:epidemiology; D003657:Decision Making; D004992:Ethics, Medical; D017144:Focus Groups; D006801:Humans; D007258:Informed Consent / Q000941:ethics* / Q000523:psychology; D026706:Paternalism / Q000941:ethics*; D028701:Patient Rights / Q000941:ethics* / Q000639:trends; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D036301:Qualitative Research