[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
April 1985

The Progression of Medicine: From Physician Paternalism to Patient Autonomy to Bureaucratic Parsimony

Author Affiliations

From the Center for Clinical Medical Ethics and the Department of Medicine, University of Chicago Pritzker School of Medicine.

Arch Intern Med. 1985;145(4):713-715. doi:10.1001/archinte.1985.00360040147031

The language used to describe the practice of medicine and the metaphors employed to depict the relationship of patients and physicians establish conceptual boundaries for such discussions and affect the practices themselves. My colleague, James Gustafson, PhD, made a similar point recently:

How the medical staff or the ethician describes persons and their relations to each other [ie, whether as "... individual contractors or persons in patterns and processes of interdependence..."] is a matter of critical judgment. The alternative descriptions back alternative ways of construing the moral situation. How that situation is construed confines or enlarges the morally relevant features to be taken into account in patient care [unpublished work, 1984].

In recent years, medical practice has been regarded (at least by most medical ethicists and by lawyers) primarily as an impersonal encounter between two isolated and autonomous persons—the patient and the physician—whose individual interests were to be rigorously protected