Autonomy and the Common Weal

Abstract

When health care providers make decisions to use resources, their devotion to the patient at hand must be mediated by a framework that puts individual autonomy and social equity into focus simultaneously. The concept of citizenship yields such a framework...The experiences of both physicians and patients have outgrown the older models of medical ethics. New intellectual paradigms are needed to reflect these more complex relationships. Developing a citizen ethic for both physicians and patients is a step toward a more adequate model. Even the most elegant model will not, of course, resolve all the tensions between respect for patient autonomy and equity of distribution, nor will it resolve the many complex issues of institutional and financial change. What we propose, however, does give explicit voice to a basic moral conflict, and engage it realistically. Engagement is the first step toward resolution.