ABSTRACT
The art of medicine has been practised for centuries. Over that time, some of its ethical foundations have been modified, reflecting the social, political and other changes that have occurred. Medical ethics have ultimately transcended the ‘closed shop’ ideology of Hippocrates, largely eschewed the dominance of paternalism and now flourish (or not) in the spotlight of autonomy. In the time since the Hippocratic Oath was first promulgated, the practice of medicine has changed dramatically and this is reflected in the way doctors now engage with patients and public alike. The rudimentary techniques available to the early physicians have been replaced by a discipline firmly grounded in science, although, of course, an element of ‘art’ remains in everyday practice. In addition, since probably around the mid-19th century, medicine has become thoroughly professionalised with the concomitant responsibilities – legal and ethical – that flow from this. Moreover, medicine, its practitioners and its patients now live in a world where the dominant language is that of human rights. The traditional, relatively simple, reliance on the physician has shifted towards recognition that those whom they serve also have legitimate interests and viewpoints, and a right to be engaged in treatment decisions. Patients’ medical interests are no longer seen as separable from their per-
sonal ones, and the assumption that the best medical advice determines the optimal outcome of the doctor/patient encounter no longer holds. Acceptance that ‘[h]ealth care choices involve profound questions that are not finally referable to professional expertise … ’1 has had significant consequences for the doctor/patient relationship. The assertion that patients have rights in making healthcare decisions is reflected in the general recognition that autonomy is the transcending principle of modern bioethics, and its influence pervades – at least in theory – every clinical encounter and every medical act. Personal choices about healthcare are taken, by and large, to be definitive,
albeit that they will often be rooted in clinical advice and recommendations. Reinforcing this notion of ‘patient power’, Schultz says that in most situations where healthcare decisions have personal consequences and cause little or no harm to others, then ‘the case for respecting patient autonomy in decisions about health and bodily fate is very strong’.2
