An authority distribution: when decisions are made by patient and when for patient?

Abstract

Background. The benefits of medical interventions are grounded well by solid evidence, mostly quantitative and positivist. This leads the healthcare system to take authoritarian position and to insist (even through policies) on actions that are set as proper, with denial of the opposite. Real clinical practice, however, introduces an issue of autonomy. On what grade “the good†is a person’s own decision, but not just prescription? When informed consent is truly informed? And when nudging goes beyond ethical? Methods. Literary review, semiotic analysis of clinical practice, and interviewing of post-myocardial infarction patients in live clinical setting with textual and discourse analysis. Findings. 1) A shaky balance outlined in “authority distribution†among healthcare participants, with focus on communication skills bound to personality of a professional. The intra-individual borderlines exist, that determine a “should†vs. “mayâ€. 2) Key phenomenal elements are listed, with suggested way of introduction into practice (e.g., the implicit experiences addressed by empathic listening; threshold for details in informed consent obtaining to be made explicit by interview structure). 3) The maturity of personhood of the professional is grounded as key element determining the grade of autonomy delegation in health related decisions for patient. Discussion. Critical analysis of the relations of evidence, authority and patients’ experiences sets a need for clinician to possess skills that make her able to 1) adequately understand patient’s implicit [“empathyâ€]; 2) influence patient’s decisions [“manipulationâ€] to the 3) felt extent of ethically appropriate with consideration of complex issues such as spiritual, culture-dependent, family, etc. [“virtueâ€].