Medicina (Buenos Aires)
versión On-line ISSN 1669-9106
COLT, Henri. Autonomy and practical identity: Cornerstones to ethical physician behavior. Medicina (B. Aires) [online]. 2006, vol.66, n.1, pp. 75-80. ISSN 1669-9106.
Three frequent problems of daily medical practice are analyzed: 1) a physicians perceived obligation to provide medical services regardless of whether ones health care institution provides monetary compensation for the medical act, 2) increasing pressures to obtain informed consent in a national context where paternalistic physician-patient interactions have been customary, and 3) a physicians professional responsibility to offer internationally recognized standard of care even if this means allocating expensive tertiary healthcare resources to a small number of patients in spite of ones knowledge that national governments are unable to provide primary care to millions of their citizens. These problems are discussed from the point of view of the ethical principle of respect for patient autonomy. Potential limiting factors (cultural, financial, religious or disease-related influences) on autonomy of patients and doctors are identified. The functions of patient autonomy in the framework of four different patient-doctor interaction models (paternalist, informative, interpretative and deliberatibe) are described. Physician leaders, health care institutions, and professional organizations are responsible for creating an environment in which doctors can discuss ethical issues as comfortably and as frequently as they discuss biological matters. Health care providers should do their best to recover the human side of medical practice which, undoubtedly, would create a greater likelihood that appropriate decisions will be made when facing complex ethical dilemmas.
Palabras clave : medical ethics; patient autonomy; medical responsibility.