Chest
Volume 139, Issue 3, March 2011, Pages 669-673
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Medical Ethics
A Brief Historical and Theoretical Perspective on Patient Autonomy and Medical Decision Making: Part I: The Beneficence Model

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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.

Section snippets

The Hippocratic Tradition

The beneficence model can be traced back to the Hippocratic Oath or, more precisely, to the texts making up the Hippocratic tradition.3 For instance, the oath itself provides that physicians will “apply dietetic measures for the benefit of the sick according to [their] ability and judgment; [and to] keep [the sick] from harm and injustice.”4 While it establishes a core set of physician responsibilities, notably absent is any language speaking to a meaningful role for the patient in the

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For editorial comment see page 488.

Editor's note: This essay addresses the first topic in the Law and Medicine curriculum of the ongoing “Medical Ethics” series. To view all articles from the core curriculum, visit http://chestjournal.chestpubs.org/cgi/collection/medethics.

Constantine A. Manthous, MD, FCCP, Section, Editor, Medical Ethics

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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