Patient Autonomy and the Ethics of Responsibility
The principle of patient autonomy dominates the contemporary debate over medical ethics. In this examination of the doctor-patient relationship, physician and philosopher Alfred Tauber argues that the idea of patient autonomy—which was inspired by other rights-based movements of the 1960s—was an extrapolation from political and social philosophy that fails to ground medicine's moral philosophy. He proposes instead a reconfiguration of personal autonomy and a renewed commitment to an ethics of care. In this formulation, physician beneficence and responsibility become powerful means for supporting the autonomy and dignity of patients. Beneficence, Tauber argues, should not be confused with the medical paternalism that fueled the patient rights movement. Rather, beneficence and responsibility are moral principles that not only are compatible with patient autonomy but also strengthen it. Coordinating the rights of patients with the responsibilities of their caregivers will result in a more humane and robust medicine.
Tauber examines the historical and philosophical competition between facts (scientific objectivity) and values (patient care) in medicine. He analyzes the shifting conceptions of personhood underlying the doctor-patient relationship, offers a "topology" of autonomy, from Locke and Kant to Hume and Mill, and explores both philosophical and practical strategies for reconfiguring trust and autonomy. Framing the practicalities of the clinical encounter with moral reflections, Tauber calls for an ethical medicine in which facts and values are integrated and humane values are deliberately included in the program of care.
About the Author
Alfred I. Tauber is the Zoltan Kohn Professor of Medicine, Professor of Philosophy, and Director of the Center for Philosophy and History of Science at Boston University.
"Tauber's mission is to correct the way the law, as well as its bioethicist and managed-care enablers, have shortchanged the moral character of medicine....[and] to turn the prevailing concept of patient autonomy on its head by getting physicians to act on their moral duties to their patients...The resulting book is impressively referenced and written and is an intellectually elegant exercise in moral philosophy.", Marshall B. Kapp, J.D., M.P.H., The New England Journal of Medicine
"In our technologized, bureaucratized, and corporatized medical system, the relationship between the clinician and the patient stands like a fragile flower buffeted by a storm. With insight and wide-ranging scholarship, Alfred Tauber analyzes how our reliance on patient autonomy must be tempered by a moral intimacy between the patient and the healer. In doing so, he offers an erudite yet deeply empathetic prescription for restoring our most precious medical resource: the doctor-patient relationship."
—Paul Root Wolpe, Department of Psychiatry and Center for Bioethics, University of Pennsylvania
"This book makes a significant contribution to bioethics. Among its greatest strengths is Tauber's ability to frame his argument in the context of several centuries of intellectual progress. By concluding with a discussion of the practical upshots for clinical practice and medical education, he grounds his reflections in such a way as to make the effort accessible to a broader audience."
—Kenneth W. Goodman, Director, Bioethics Program, University of Miami