Abstract
The overall aim of this thesis was to identify and analyse situations raising the question of possible paternalism in everyday general practice in Sweden. Both questionnaires to a random sample of respondents and interviews have been used.
The ethical awareness among GPs in Sweden and the variety of ethical issues, suggest that medical ethics is a subject of high relevance in general practice. This indicates the need of both enhanced education in medical ethics, as well as better opportunities and time for ethical discussion and deliberation with colleagues.
Facing a reluctant patient the GP often consider other obligations more important than respect for the patient’s right to self-determination. The fear of infringing the patient’s right to self-determination is often over-estimated by the GPs. When facing a demanding patient, the general public often expect the GP to accept the demand, while the GP often would reject it. The general public seem to have high expectations on the health care services.
Paternalistic actions are common in Swedish general practice. In order to justify an action or omission, the GP uses promotion of medical benefit or protection from harm, more frequently than promotion of the patient’s right to autonomy. As an expression of “the patient’s best interest” this may be justified, but only as long as the GP also find out and usually respect the patient’s wishes.
The ethical awareness among GPs in Sweden and the variety of ethical issues, suggest that medical ethics is a subject of high relevance in general practice. This indicates the need of both enhanced education in medical ethics, as well as better opportunities and time for ethical discussion and deliberation with colleagues.
Facing a reluctant patient the GP often consider other obligations more important than respect for the patient’s right to self-determination. The fear of infringing the patient’s right to self-determination is often over-estimated by the GPs. When facing a demanding patient, the general public often expect the GP to accept the demand, while the GP often would reject it. The general public seem to have high expectations on the health care services.
Paternalistic actions are common in Swedish general practice. In order to justify an action or omission, the GP uses promotion of medical benefit or protection from harm, more frequently than promotion of the patient’s right to autonomy. As an expression of “the patient’s best interest” this may be justified, but only as long as the GP also find out and usually respect the patient’s wishes.
| Original language | English |
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| Qualification | Doctor |
| Awarding Institution |
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| Supervisors/Advisors |
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| Award date | 2004 Dec 3 |
| Publisher | |
| ISBN (Print) | 91-628-6317-7 |
| Publication status | Published - 2004 |
Bibliographical note
Defence detailsDate: 2004-12-03
Time: 10:15
Place: Segerfalksalen, Sölvegatan 17, Lund
External reviewer(s)
Name: Lynöe, Niels
Title: [unknown]
Affiliation: Centre for Bioethics, Karolinska Institutet, SE-171 77 Stockholm
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Article: I. Bremberg S, Nilstun T. Patient’s autonomy and medical benefit: ethical reasoning among general practitioners. Family Practice 2000; 17: 124-8.
Article: II. Bremberg S, Nilstun T. The variety of ethical issues in everyday practice – interviews with Swedish GPs. European Journal of General Practice 2001; 7: 143-7.
Article: III. Bremberg S, Nilstun T, Kovac V, Zwitter M. GPs facing reluctant and demanding patients: analysing ethical justifications. Family Practice 2003; 20: 254-61.
Article: IV. Bremberg S, Nilstun T. Justifications of physician’s choice of action – Attitudes among the general public, GPs and oncologists in Sweden. Submitted.
Article: V. Bremberg S, Nilstun T. Patient’s right to self-determination and medical benefit – Swedish GPs’ justification and description. Submitted.
Subject classification (UKÄ)
- Medical Ethics
Free keywords
- autonomy
- Attitudes
- interview
- justification
- medical benefit
- paternalism
- questionnaire
- General practice
- medicinsk utbildning
- medical training
- Allmän medicinsk utövning