The Practice of Autonomy: Patients, Doctors, and Medical Decisions

by Carl E. Schneider

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.

Genres: Medicine

336 pages, Hardcover

First published October 29, 1998

Reviews

[Samuel Brown · Rating 4 out of 5]

This is a great and thoughtful book. Writing style is pleasing and content is useful. I worry some that his final proposals are impractical in terms of expectations about how much additional physician time/loss in efficiency can be managed within the current medical system. But he is absolutely correct that the autonomy paradigm can be enriched by additional work that acknowledges the problems with autonomism as it has been elaborated within traditional bioethics.

[Kelly · Rating 4 out of 5]

4.5 stars. I read this book for work (I’m a PhD researcher in medical ethics and medical decision making). The book raises really important and interesting objections to the over-focus on autonomy in bioethics and medical care, backed by interesting empirical data (and lots of selections from patient memoirs, which was an interesting data source I hadn’t explored before). As is often the case with these sorts of books, Schneider is somewhat reluctant to provide solutions to the problems he’s outlining in the book, largely because of just how complex they are, though he does point out some useful avenues for potential solutions. I recognize by now that this is pretty much par for the course for books about medical ethics, but some readers might find it irritating. Also, it was a bit disheartening to reflect on the fact that even though this book was written over 20 years ago, the problems it outlines still very much exist and are, if anything, more pronounced. Clearly more people need to read this book, which I definitely recommend doing if you’re at all interested in medicine.