Comment: Autonomy vs beneficence.

Abstract

The dialogue between autonomy and beneficence is ages old. Doing what the patient wants is not always consonant with doing what one believes is good and right for the patient. Inner conflict for the physician lies on both sides of this issue. As illustrated by the articles by Ronan1 and Daly et al.,2 it is just as hard to live with giving the judgmentally competent patient the right not to be treated when the outcome of treatment is likely to be good as with doing everything possible for a patient, predicting or even promising a good outcome, only to have the actual outcome make one question the quality of that saved life. Part of physician discomfort with both of these situations derives from the notion that the medical community can correctly and unambiguously identify what is or is not good and right for a given patient. Several recent studies have generated results that fly in the face of that notion and the long-held concept that there is a core set of moral and ethical values that are independent of context.3–6 Given that culture, environment, professional domain, and personal and family history can influence that ethical core, it is perhaps not surprising that what their nonphysician patients chose to do or have done sometimes makes physicians feel uneasy in not having done what is in keeping with their own moral and ethical code.