Substantial critiques of the concept of patient autonomy have been made in recent years. The driving edge of these critiques has been to see human persons as essentially relational rather than atomistic individuals. The pay out of such a critique is that the much lauded principle of autonomy becomes less clean and neat, and instead is as complex as the multi-level analysis of human community. I am curious about the flip side of the doctor-patient relationship.
Traditionally autonomy has been regarded as patient autonomy, but I wonder how the status of the doctor might affect our understanding of the status of patients. It seems to me that patients do not want their doctors to be autonomous individuals, insofar as autonomy means a purely self-determined individual. When our health is at stake, we want the collective wisdom and resources of the medical community to bear down on our particular situation. Peer-review and case consultations among doctors are a supremely good thing as they help to net out inevitable human errors and generally increases the likelihood of a favorable outcome being achieved. Thus, we have no problem imagining doctors as working within a community to deliberate and reach important decisions about diagnosis and treatment. Why then is it so often insisted that a patient exhibit a pure kind of individualistic autonomy when they are sitting in the examination room? On the traditional account of autonomy there exists an asymmetry of relational status between the doctor and the patient. But is this asymmetry with respect to recourse to community justified?
I am always curious about what happens when a doctor becomes sick. Do they take off their stethoscope and slip easily into the role of being a patient, at the mercy of another doctor's care? Imaginably there is a spectrum of behaviors among doctors, but I cannot imagine that they ever really leave behind their identifying role as a doctor. Conceivably, the same practices and behaviors that the doctor engages in while practicing are also brought to bear on their situation as a patient when they become sick. Thus the community entrenched doctor is also the community entrenched patient when he or she becomes sick. So why then should the average joe or jill patient be expected to operate in a different manner, namely as an isolated individual making sometimes very difficult decisions about their health? Patients bring their own communities into an examination room just as a doctor become patient would. So why the difference, why the asymmetry?
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