Paternalism in general practice - physician's power and patient's autonomy

Abstract: The overall aim of this thesis was to identify and analyse situations raising the question of possible paternalism in everyday general practice in Sweden. Both questionnaires to a random sample of respondents and interviews have been used. The ethical awareness among GPs in Sweden and the variety of ethical issues, suggest that medical ethics is a subject of high relevance in general practice. This indicates the need of both enhanced education in medical ethics, as well as better opportunities and time for ethical discussion and deliberation with colleagues. Facing a reluctant patient the GP often consider other obligations more important than respect for the patient’s right to self-determination. The fear of infringing the patient’s right to self-determination is often over-estimated by the GPs. When facing a demanding patient, the general public often expect the GP to accept the demand, while the GP often would reject it. The general public seem to have high expectations on the health care services. Paternalistic actions are common in Swedish general practice. In order to justify an action or omission, the GP uses promotion of medical benefit or protection from harm, more frequently than promotion of the patient’s right to autonomy. As an expression of “the patient’s best interest” this may be justified, but only as long as the GP also find out and usually respect the patient’s wishes.