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May 17, 1985

The Silent World of Doctor and Patient

Author Affiliations

The University of Texas Health Science Center Houston

JAMA. 1985;253(19):2897. doi:10.1001/jama.1985.03350430113040

In this thoughtful and important book, Jay Katz takes us on a journey through medical and legal history to establish convincingly one point— that medical and legal relationships and entitlements up to the 20th century have developed in a manner that has kept patients out of the process of decision in which the harms and benefits of therapeutic alternatives concerning them were weighed and balanced.

In medicine, for centuries, such exclusion was justified on the basis of things such as the medical ignorance of patients, their intolerance of uncertainty, the need to maintain the patient's hope that things would improve, the simplicity that unilateral decision making gave to the doctor's life, the painfulness of discussing with patients dreaded events and hopeless prognoses, and the authority that silence in the medical relationship gave to physicians.

In the law, too, the rights given to patients up to the mid-20th century were basically