Letters to the Editor

Patient Autonomy: Reflections from a Developing Country


Am Fam Physician. 2005 Apr 1;71(7):1261.

to the editor: Family medicine is a discipline that has always supported a patient’s right to medical care. Family physicians are advocates for their patients and consider them as equal partners in their health care. Our primary focus as family physicians is on the development and maintenance of a trusting relationship with our patients.1,2

It is interesting that in the developed world an autonomy-based model of medical practice exists that has evolved from a more paternalistic model.3 In parts of the developing world, there is still a paternalistic model of medical practice that is now reported to be in transition toward a model based more on patient autonomy.4

The traditional paternalistic model of medical practice assumes that the physician knows what is best for the patient.4 The patient in such a model is a passive recipient of the medical care, which violates fundamental patient rights and therefore cannot be supported. However, the good aspect of such a model is the trust that a patient has in his or her physician,5 which unfortunately can be violated.

The patient autonomy model of medical practice protects patient rights, gives them partnership status in their health care, and involves them in the decision making process. However, this can sometimes have detrimental consequences for the trusting relationship that existed between the physician and the patient. The focus is on providing care to the patient while safeguarding against a possible lawsuit. This can seriously erode the trust between physician and patient.

We, in the developing world, are perhaps witnessing the gradual demise of the strong paternalistic model of medical practice; this is a welcome happening, but at the same time we are wary of the possible advent of a strong patient-autonomy–based model, whereby the trusting relationship is likely to be eroded.

There are good aspects in both of these models of medical practice. Physicians should ensure to keep them in order to guarantee patient rights and maintain the trust in the physician-patient relationship.

We, as primary care physicians, are in an ideal situation to ensure medical practice that is ethical and based on dignity and respect for physicians and patients.


show all references

1. Fugelli P. James Mackenzie Lecture. Trust — in general practice. Br J Gen Pract. 2001;51:575–9....

2. Parchman ML, Burge SK. The patient-physician relationship, primary care attributes, and preventive services. Fam Med. 2004;36:22–7.

3. Shelstad K. Landmark United States biomedical ethics cases: a selected bibliography. Med Ref Serv Q. 1999;18:27–53.

4. Qidwai W. Paternalistic model of medical practice. J Coll Physicians Surg Pak. 2003;13:296.

5. Rachagan SS, Sharon K. The patient’s view. Med J Malaysia. 2003;58(suppl A):86–101.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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