By Stephen McAndrew.

Traditionally, physicians worked in practices owned and operated by physicians as this was thought to ensure that physician judgment concerning patient treatment was not affected by outside non-medical factors. This meant that physicians were seen as autonomous professionals using their education and skill in medical science to treat patients. Increasingly physicians work in organizations that are run by non-physicians. Private and public health insurance requirements also affect physician discretion in treating their patients.  These changes can impact the autonomy of physicians in treating patients based on their best judgment. Also, there has rightly been much written on the need for patient autonomy and the need for physicians to take into account the values and desires of patients.  But is the autonomy of physicians being neglected? If physicians are merely required to do what the organizations they work for or their patients request, is something deeper about the role of a physician as an autonomous professional lost?

If physicians are not free to treat patients based on what they consider to be the best medical course, then patients are losing out by not receiving the best possible care. Moreover, if physicians are not seen to be autonomous professionals and their decisions are influenced by the interests of the organizations that employ them, or by insurance or pharmaceutical companies, then that may lead to decreases in patient trust.  So, there is a case to be made that physician autonomy benefits society as a whole.

I felt that physician autonomy in the light of the current medical industry deserves greater theoretical consideration. So, in my paper I put forward a case that if physicians are professionals it means they have autonomy in providing medical treatment and that treating them as autonomous professionals is beneficial for society as a whole. I hope that this paper leads to more discussion of what it means to be a physician in a world where the ownership and operation of medical practices is increasingly more complicated.

Paper title: Internal Morality of Medicine & Physician Autonomy

Author(s): Stephen McAndrew

Affiliations: University at Buffalo, Department of Philosophy

Competing interests: None

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