Physician Choice or Patient
Choice: Ethical Dilemmas in
Science and Politics
Centre for Applied Ethics, Philosophy Section, University of Wales, Cardiff, UK
The purpose of this chapter is to explore the balance that must exist between the physician and the patient in determining the patient’s access to pharmaceuticals and other medical therapies. It is hardly novel to observe that the second half of the twentieth century has seen a fundamental challenge to the culture of medical paternalism, in which the physician—albeit in the supposed best interests of the patient—dictated the form of therapy which the patient would undergo. The recognition of a raft of patients’ rights, the rise of patient advocacy groups, as well as increased patient involvement in determining the goals and values of medicine has fundamentally transformed medical culture. The decline of medical paternalism has, inevitably, served to make medical decision-making more complex, as the simple certainties of paternalism are replaced by increasingly problematic negotiations, and often negotiations between parties that share surprisingly little in the way of culture or knowledge. The complexity of the decision-making process reverts, at least in part, to the problem of determining what information and value positions can legitimately be brought to these negotiations. At its crux is the problem of determining when the position of one
Pharmaceutical Ethics. Edited by S. Salek and A. Edgar. © 2002 John Wiley & Sons, Ltd.