Abstract:
BACKGROUND:Patient autonomy has gradually replaced physician paternalism as an ethical ideal. However, in a medical context, the principle of individual autonomy has different meanings. More knowledge is needed about what is and should be an appropriate understanding of the concept of patient autonomy in clinical practice. AIM:To challenge the traditional concept of patient autonomy by applying a discourse analysis to the issue. METHOD:A qualitative case study approach with material from one consultation. The discourse is interpreted according to pragmatic and text-linguistic principles and provides the basis of a theoretical discussion of different concepts of patient autonomy. RESULTS:The consultation transcript illustrates how the patient's wishes can be respected in real life. The patient, her husband and the doctor are all involved in the discourse dynamics, governed by the subject matter, namely her mental illness. CONCLUSION:We suggest a dynamic and dialogue-based conception of autonomy as adequate for clinical purposes. These perspectives, based on mutual understanding, take communication between patient and doctor as their starting point. According to this approach, autonomy requires a genuine dialogue, an interpersonal mode of being which we choose to call "authentic interaction".
journal_name
J Med Ethicsjournal_title
Journal of medical ethicsauthors
Nessa J,Malterud Kdoi
10.1136/jme.24.6.394subject
Has Abstractpub_date
1998-12-01 00:00:00pages
394-400issue
6eissn
0306-6800issn
1473-4257journal_volume
24pub_type
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pub_type: 评论,杂志文章
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