The origins and consequences of patient autonomy: A 25-year retrospective

This essay explores the evolution of the tension between the principles of autonomy and beneficence in American health care over the past several deca des. In retrospect it is clear that the social movements of the 1960s and 7 0s set the tone and the goals for the emergence of a new emphasis on patien t autonomy. Indeed, the impact of civil liberties-minded lawyers on the pro motion of a commitment to autonomy is far more vital than the term "bioethi cs'' commonly suggests. Tracing the impact of this principle on clinical en counters over the past 25 years makes apparent that consumers have extended their influence over a wide range of treatment decisions. This influence i s now being reinforced by an extraordinary information revolution, which in cludes the computer, the web, the dot.coms, the search engines, and such no vel practices as Direct-to-Consumer advertising by pharmaceutical companies . The impact of these developments may be seen in such diverse issues as ph ysician-assisted suicide and the failure of national health insurance initi atives.