The Practice of Autonomy Patients, Doctors, and Medical Decisions

by Schneider, Carl E.

• ISBN13: 9780195113976
• ISBN10: 0195113977
• Format: Hardcover
• Copyright: 1998-10-29
• Publisher: Oxford University Press

Summary

This is a book written across the grain of contemporary ethics, where the principle of autonomy has triumphed.It is an attempt to see the law of medicine, the principles of bioethics, and the encounter between doctor and patient from the patient's point of view. While Schneider agrees that many patients now want to make their own medical decisions, and virtually all want to be treated with dignity and solicitude, he argues that most do not want to assume the full burden of decision-making that some bioethicists and lawyers have thrust upon them. What patients want, according to Schneider, is more ambiguous, complicated, and ambivalent than being "empowered." In this book he tries to chart that ambiguity, to take the autonomy paradigm past current pieties into the uncertain realities of modern medicine.

Table of Contents

Introduction	xi
Medical Decisions in the Age of Informed Consent	xi	(4)
Logic and Experience	xv
1. The Autonomy Paradigm	3	(32)
The Paradigm in Bioethics and Law	3	(6)
The Paradigm in Excelsis	9	(23)
The Paradigm in Crisis	32	(3)
2. Patients' Preferences About Autonomy: The Empirical Evidence	35	(12)
Direct Empirical Evidence	36	(5)
Some Substantiating Evidence	41	(6)
3. The Reluctant Patient: Can Abjuring Autonomy Make Sense?	47	(62)
The Daunting Difficulty of Medical Decisions	48	(27)
The Life of the Sick	75	(12)
The Divided Self	87	(5)
How Do Patients Make Medical Decisions?	92	(7)
How Can Doctors Make Medical Decisions?	99	(10)
4. How Can They Think That?: Of Information, Control, and Complexity	109	(28)
Knowledge	110	(3)
Control	113	(14)
Complexity: The Varieties of Medical Decision	127	(8)
Conclusion	135	(2)
5. Reconsidering Autonomy: Evaluating the Arguments for Mandatory Autonomy	137	(49)
The Prophylaxis Argument	138	(5)
The Therapeutic Argument	143	(8)
The False-Consciousness Argument	151	(2)
The Moral Argument	153	(23)
Conclusion	176	(5)
6. Beyond the Reluctant Patient: Autonomy in New Times	181	(48)
Choosing Not to Choose	182	(4)
The Autonomy Paradigm and the Bureaucratization of Medicine	186	(9)
What Do Patients Want? Bureaucracy, Bioethics, and the Depersonalization of Medicine	195	(11)
From Consumer Choice to Consumer Welfare	206	(23)
7. Conclusion	229	(4)
Notes	233	(68)
Index	301