Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship - Attitudes among Norwegian physicians

Sixteen statements on physician attitudes in the physician-patient relation ship were presented to a representative sample of Norwegian physicians (N=9 90). Three moderately correlated theoretical dimensions were identified in a principal component analysis: paternalism, patient autonomy, and moral de liberation. The paternalism scores increased significantly with age, and ps ychiatrists scored significantly lower than physicians in somatic specialti es. Psychiatrists had the highest scores on the patient autonomy dimension, whereas surgeons scored the lowest. Moral deliberation scores increased sl ightly with age. To explore the pattern of scores across the three dimensio ns, the scores were dichotomized and combined in eight different ways. The resulting typology included five different physician profiles: (1) classica l paternalists (high scores on paternalism, low scores on both patient auto nomy and moral deliberation), (2) modern paternalists thigh scores on both paternalism and deliberation, low scores on patient autonomy), (3) autonomi sts (high scores on patient autonomy, low scores on both paternalism and de liberation), (4) deliberationists (high scores on deliberation and patient autonomy, low scores on paternalism), and (5) ambivalents thigh or low scor es on all dimensions, or high or low scores on both paternalism and patient autonomy). The four groups of physicians with 'consistent' attitudes conta ined between 12 and 19% of the total sample, whereas 37% belonged to the 'a mbivalent' group. Laboratory doctors and surgeons belonged significantly mo re often in the group of classical paternalists than did general practition ers, whereas male physicians were more often modern paternalists than were female physicians. Among the autonomists, women were more numerous than men , doctors in their 40s clearly more numerous than those in their 60s, and p sychiatrists clearly more numerous than residents. (C) 2000 Elsevier Scienc e Ltd. All rights reserved.