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Tell Me What's Wrong with Me: A Discourse Analysis Approach to the Concept of Patient Autonomy
John Nessa and Kirsti Malterud
Journal of Medical Ethics
Vol. 24, No. 6 (Dec., 1998), pp. 394-400
Published by: BMJ
Stable URL: http://www.jstor.org/stable/27718202
Page Count: 7
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Background—Patient autonomy has gradually replaced physician paternalism as an ethical ideal. However, in a medical context, the principle of individual autonomy has different meanings. More knowledge is needed about what is and should be an appropriate understanding of the concept of patient autonomy in clinical practice. Aim—To challenge the traditional concept of patient autonomy by applying a discourse analysis to the issue. Method—A qualitative case study approach with material from one consultation. The discourse is interpreted according to pragmatic and text-linguistic principles and provides the basis of a theoretical discussion of different concepts of patient autonomy. Results—The consultation transcript illustrates how the patient's wishes can be respected in real life. The patient, her husband and the doctor are all involved in the discourse dynamics, governed by the subject matter, namely her mental illness. Conclusion—We suggest a dynamic and dialogue-based conception of autonomy as adequate for clinical purposes. These perspectives, based on mutual understanding, take communication between patient and doctor as their starting point. According to this approach, autonomy requires a genuine dialogue, an interpersonal mode of being which we choose to call "authentic interaction".
Journal of Medical Ethics © 1998 BMJ