When Patient and Doctor Disagree

Since the beginning of Western Medicine nearly 2500 years ago with Hippocrates, the essential ground rule for the professional relationship between patient and doctor has remained the same, namely the patient relies on the knowledge and integrity of the doctor. There has been a striking disparity of power in this relationship, very much in favour of the doctor. In recent years much has changed. Not only have there been huge advances in medical knowledge, but patients have themselves become more knowledgeable, mainly due to the internet and the establishment of voluntary bodies which disseminate information about the diagnosis and treatment of illnesses. As a consequence, the so-called paternalistic medical approach is slowly giving way to patient-centered medicine in which the autonomy of patients becomes increasingly important. This has inevitably led to some differences of opinion between patients and doctors. This book advances philosophical arguments in favour of patient autonomy and describes some of these differences of opinion as they arise in psychiatric practice. It includes chapters on various restrictions, especially compulsory detention, imposed on patients under the Mental Health Act, epistemic injustice, do-not-resuscitate orders and assisted suicide, in which the issues are discussed from both a philosophical and psychological perspective. The book will be of interest to all professionals and non-professionals who are interested in ethical dilemmas which often arise in psychiatry.