ABSTRACT
Respect for autonomy has become the major guiding principle in healthcare ethics. This may not always be in the interest of the patient and society, and many consider that the balance between autonomy and paternalism has swung too much in favour of autonomy. This chapter addresses these issues by examining some of the theoretical concepts of autonomy and paternalism, and applying them to situations that arise in primary care. Issues of confidentiality and truth-telling are relevant to a consideration of autonomy and paternalism, but the main emphasis will be on decision-making within the consultation. The chapter presents a case study for these issues. In healthcare, autonomy is highly valued and the autonomous person is seen as rational and independent. Autonomy can be considered as a spectrum or continuum in another way. Preventing disease and promoting the health of patients is becoming an increasingly important role for the practice team and is now linked to practice income.
