ABSTRACT

Increasing patient choice has become a major theme in planning and improving health services. Despite the destructive impact of suffering on the range of patient choice, general practitioners can reduce the apparent incompatibility by realising that there are different sorts of choice. Not all choices have the same structure; they do not all make the same demands on those who choose or those who react and respond to the choices; the roles that people are to adopt in these transactions are not always the same. The choices practitioners face in cases of serious ill-health require a much more personally engaged sort of knowledge than is captured by the word ‘information’. This chapter emphasizes it is not lack of information that makes these choices difficult, but poor understanding of ourselves and the aims that we can sustain as our situation changes. Autonomy, freedom of choice and informed consent are part of the package of notions that go with consumerism and contract.