Final responsibility for treatment choice: the proper role of medical doctors?

Abstract

Aims: To analyse whether the traditional allocation of decision-making responsibility is still justifiable. And, if not to analyse the strength of claims made by other health care professions and by patients.

Background: Traditionally doctors have been responsible for choices of treatment, both in terms of deciding and in terms of taking responsibility for the decisions. But modern health care work often takes place in teams involving health care professionals from different professions as well as the patient. In such teams it may not be obvious who should be responsible for treatment choice.

Methods: Philosophical analysis of epistemic, ethical and organizational arguments, including analysis of the historical origins of these arguments.

Results: The epistemic, ethical and organizational arguments for maintaining a primary decision making role for doctors are not sound. Other health care professionals can, in some circumstances make stronger and more justified claims. The arguments against allocation decision making authority to patients are also invalid or unsound in many circumstances.

Conclusion: There are many situations in which final responsibility for treatment choice should rest with health care professionals who are not doctors and with patients.