Tell me what's wrong with me: a discourse analysis approach to the concept of patient autonomy

Author(s): Malterud, K.

Journal/Book: J Med Ethics. 1998; 24: Tavistock House East, Tavistock Square, London, England WC1H 9Jr. Prof Sci Publ. 394-400.

Abstract: 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 rite patient's wishes can be respected in real life. The patient, her husband and the doctor are all involved ii? 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 toe choose to call ''authentic interaction''.

Note: Article Nessa J, Univ Bergen, Dept Publ Hlth & Primary Hlth Care, Div Gen Practice, Bergen, NORWAY

Keyword(s): patient-doctor encounter; discourse analysis; patient autonomy; vital lies; authenticity

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