(Correspondence) Paternalism and the Physician’s Conscience

Julia E Connelly

Annals of Internal Medicine
Annals of Internal Medicine

Journal Extract
I read Dr. Thomasma’s article (1) with skepticism. All models for the doctor-patient relationship are shortsighted as they do not acknowledge systems of relationships beyond that of the physician and the patient. Despite this inherent shortcoming, Thomasma’s model contains two characteristics that distinguish it from other such models. Both the strength of his physician conscience model and its greatest limitations exist in these two characteristics. First, his model requires that physicians assess beliefs, attitudes, and emotions they recognize in response to their patients in an effort to determine how these factors influence the health care they provide. . .


Connelly JE. (Correspondence) Paternalism and the Physician’s Conscience. Ann Intern Med. 1983 Aug 01;99(22):276.

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

David C Thomasma

Annals of Internal Medicine
Annals of Internal Medicine

Abstract
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.


Thomasma DC. Beyond Medical Paternalism and Patient Autonomy: A Model of Physician Conscience for the Physician-Patient Relationship. Ann. Intern. Med.. 1983;98(2):243-248.