A brief historical and theoretical perspective on patient autonomy and medical decision making: Part I: The beneficence model

Chest. 2011 Mar;139(3):669-673. doi: 10.1378/chest.10-2532.


As part of a larger series addressing the intersection of law and medicine, this essay is the first of two introductory pieces. This article explores the nature of the physician-patient relationship and of the practice of medicine dating from the Hippocratic tradition to the end of the 19th century, a period during which a beneficence-based medical ethic remained relatively stable. The medical literature dating from the Hippocratic texts to the early codes of the American Medical Association did not include a meaningful role for the patient in the decision-making process. In fact, the practice of benevolent deception--the deliberate withholding of any information thought by the physician to be detrimental to the patient's prognosis--was encouraged. However, as philosophers identified an inherent value in respecting patient self-determination and the law imposed a duty on physicians to obtain informed consent, 2,400 years of relative stability under the beneficence model gave way to the autonomy model.

Publication types

  • Historical Article

MeSH terms

  • American Medical Association / history
  • Decision Making / ethics*
  • Decision Support Techniques*
  • Ethics, Medical / history*
  • Hippocratic Oath
  • History, 15th Century
  • History, 16th Century
  • History, 17th Century
  • History, 18th Century
  • History, 19th Century
  • History, Ancient
  • History, Medieval
  • Humans
  • Patient Participation / history
  • Patient Rights / ethics
  • Patient Rights / history*
  • Patient Rights / legislation & jurisprudence
  • Physician-Patient Relations / ethics
  • Physicians / ethics
  • Physicians / legislation & jurisprudence
  • Quality of Health Care / ethics
  • Quality of Health Care / legislation & jurisprudence
  • Quality of Health Care / standards
  • United States