Lecture Two: Jan.13.2011
PRINCIPALS OF AUTONOMY
The right to self-governance (the ability to make your own decisions)
Case: Suppose you are a physician who specializes in treating mental illness. You have a
patient named John. John has been in and out of mental institutions within the past
couple of years, he has bi-polar disorders. He also suffers from some pretty serious
delusions, he claims himself to be the best scientist, he claims he is a wrestler, he claims
that he is in regular communication with the supernatural world; he also claims that he
is very good at doing physics. John becomes your patient because he has a history of
uttering death threats to people—this has gotten him in trouble with the law. He was
put on trial and it was determined that he is not criminally responsible due to his mental
illness. You look at his case, and you determine that over time his condition has been
getting worse; unless a serious type of treatment is taken. Hence if this doesn’t occur
he cannot function external to the institution. You discover that there is a new
medication which has not been used before; however you think it might help him regain
his consciousness. You recommend the medication to John in order to help him
overcome the mental illness. Johns response is NO. What should be done in this type
This case brings upon a great emphasis on the physician-patient relationships.
When thinking about the physician-patient relationships we need to consider…
1. Goals of the physician-patient relationship
2.What are the duties/obligation of the physician?
3. What is the role of the patient’s values?
4. How do they conceive autonomy?
There are four models within the Physician-patient relationships:
Thinks of the relationship of the physician-patient, based on the same of a parent and child.
Takes on the belief that because a parent knows best, the physician knows best
The paternalistic model has goals which include:
a. Promoting the patients well being and health
b. Put the patients first (do what you think is best for the patient).
This goal claims that there are objective values which are being
An example of an objective value could be HEALTH.
Therefore, the objective value of health held within this model;
suggests that anything should be done in order to maintain health.