From physician paternalism to patient autonomy: 25 centuries of history

Abstract

From its origins, the doctor-patient relationship accompanied the social and cultural changes that have been modeling different forms of interhuman relationships. However, paternalism remained almost unchanged. Only in the 1970s, hand in hand with postmodern thought and the centrality of ethical, psychological, social and anthropological disciplines, respect for the autonomy of patients began to develop, which constituted the essence of a radical change. “Four models of doctor-patient relationship” are described depending on the objectives of the interaction between the actors, the doctor’s obligations and the patient’s values. Some particularities are detailed in the decision-making of children and adolescents, the doctrine of the mature minor, and progressive autonomy where the need for informed consent that reflects the autonomy of this age group is evident. It is worth highlighting the importance of communication in the development of a relationship in which the different models can collaborate with a genuine practice of autonomy for patients and their families.