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Beyond Medical Paternalism and Patient Autonomy: A Model of Physician Conscience for the Physician-Patient Relationship

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▸Requests for reprints should be addressed to David C. Thomasma, Ph.D.; Loyola University Stritch School of Medicine, 2160 S. First Avenue; Maywood, IL 60153.

Maywood, Illinois

© 1983 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1983;98(2):243-248. doi:10.7326/0003-4819-98-2-243
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Medical paternalism lies at the heart of traditional medicine. In an effort to counteract the effects of this paternalism, medical ethicists and physicians have proposed a model of patient autonomy for the physician-patient relationship. However, neither paternalism or autonomy are adequate characterizations of the physician-patient relationship. Paternalism does not respect the rights of adults to self-determination, and autonomy does not respect the principle of beneficence that leads physicians to argue that acting on behalf of others is essential to their craft. A model of physician conscience is proposed that summarizes the best features of both models—paternalism and autonomy.





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