The Practice of Autonomy: Patients, Doctors, and Medical Decisions

This is a book written across the grain of contemporary ethics, where the principle of autonomy has triumphed.It is an attempt to see the law of medicine, the principles of bioethics, and the encounter between doctor and patient from the patient's point of view. While Schneider agrees that many patients now want to make their own medical decisions, and virtually all want to be treated with dignity and solicitude, he argues that most do not want to assume the full burden of decision-making that some bioethicists and lawyers have thrust upon them. What patients want, according to Schneider, is more ambiguous, complicated, and ambivalent than being "empowered." In this book he tries to chart that ambiguity, to take the autonomy paradigm past current pieties into the uncertain realities of modern medicine.

Table of Contents:
1. The Autonomy Paradigm 2. Patients Preferences About Autonomy: The Empirical Evidence 3. The Reluctant Patient: Can Abjuring Autonomy Make Sense? 4. How Can They Think That: Of Information, Control, and Complexity 5. Reconsidering Autonomy: Evaluating the Arguments For Mandatory Autonomy 6. Beyond the Reluctant Patient: Autonomy in New Times

Review :
noted in JAMA February 16, 2000 "...the most comprehensive, organized summary and analysis to date of the quantitative and qualitative empirical research on the actual process of medical decision making....a scholarly, insightful rejection of the contemporary bioethical wisdom that the making of complex medical decisions can be reduced to a single, uniform, legally enforcable model....Schneider supports the principle of patient autonomy. But at the same time, he effectively deflates its most unrealistic, and arguably undesirable, pretensions. He sums up his work by observing that 'informing our bioethical thinking with an understanding of how the world works will richly reward the effort.' His intended audience of physicians, bioethicists, attorneys, and social scientists should agree strongly with this assessment."---The New England Journal of Medicine noted in Micigan Law Review May 1999 "The book is a gold mine of surprising insights into patient needs, medicine, and physician-patient relationships- which alone justifies it purchase."--Religious Studies Review His work will enrich the ongoing debate and that, one hopes, will lead to a clearer statement of law, ethics, and public policy on both the principles and the practice of autonomy and the matter of consent to treatment generally. This is a book that even those who think they know autonomy and consent to treatment inside and outwill find worth reading.--he Journal of Legal Medicine "This book raises important questions about the relationship between ethical theory and daily practice. Schneider's critical exploration of both the principle of autonomy and the clinical practice will inspire bioethicists and lawyers as well as all professionals who work with patients." -- Bert Molewijk, Medicine, Health Care and Philosophy: A European Journal 3: 2000