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Invited Commentary
May 9, 2011

A Swinging PendulumComment on “On Patient Autonomy and Physician Responsibility in End-of-Life Care”

Author Affiliations

Author Affiliations: From the Palliative Care Service and Optimum Care Committee, Massachusetts General Hospital, the Harvard Medical School Center for Palliative Care (Dr Krakauer), and the Department of Global Health and Social Medicine (Dr Krakauer), Harvard Medical School, Boston, Massachusetts. Dr Billings currently holds no institutional affiliation.

Arch Intern Med. 2011;171(9):854. doi:10.1001/archinternmed.2011.173

It is only recently in the history of medicine that patient self-determination has taken center stage in medical decision making. Autonomy emerged as a core principle of medical ethics as a result of multiple factors, including (1) the publication of exposés regarding patient safety in medical research,1 (2) the transition of medicine from an art to a contractual marketplace enterprise and associated erosion of trust between patient and physician,2 (3) the introduction of sophisticated therapies that may or may not prolong life or improve its quality, and (4) an increasingly educated public. Patient autonomy has been formalized in law through judicial rulings supporting patients' right to control what is done their own bodies, including their right to refuse treatment.35 The Patient Self-Determination Act6 in 1990 further solidified patient rights to make health care decisions, appoint surrogate decision makers, and complete advance directives.

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