Law Quadrangle (formerly Law Quad Notes)


In The Practice of Autonomy: Patients, Doctors, and Medical Decisions (Oxford University Press, 1998), Professor Carl E. Schneider, '79, examines the Iaw of bioethics by looking at the lives of patients. He argues that bioethics has reached a point of paradox : Bioethicist increasingly seem to think patients have a duty to make their own medical decisions, but it is increasingly clear that many patients do not want to do so. The following excerpt from the chapter "The Reluctant Patient' is part of Schneider's attempt to show why patients may be reluctant to seize the gift of autonomy that the law of bioethics seeks to offer them. This edited excerpt is printed with permission

To appreciate the force of the second reason patients might reject the leading role in their m medical decisions, we should recall the syllogism that lies silent at the heart of the autonomist paradigm: People want to make all decisions that shape their lives. Few decisions matter more than medicines life-or-death. sickness-or-health, fit-or-frail choices. Therefore patients want to make their own medical decisions. This syllogism is flawed because some patients conclude they will reach wiser decisions by deferring to the experience and judgment of someone else. But the syllogism errs in other ways, ways suggested by what Talcott Parsons called the 'sick role, with how people feel when they are ill." The autonomy paradigm rests on assumptions about the natural desire of all people to control themselves and their surroundings. These assumptions are overstated even for the population at large. But sick people differ from health people, for they often feel frightened, discouraged, dull-witted, abstracted, uninterested, and weary These feelings, I will now suggest, may inhibit them from making medical decisions.