Beyond medical paternalism and patient autonomy: a model of physician conscience for the physician-patient relationship.

Medical paternalism lies at the heart of traditional medicine. In an effort to counteract the effects of this paternalism, medical ethicists and physicians have proposed a model of patient autonomy for the physician-patient relationship. However, neither paternalism or autonomy are adequate characterizations of the physician-patient relationship. Paternalism does not respect the rights of adults to self-determination, and autonomy does not respect the principle of beneficence that leads physicians to argue that acting on behalf of others is essential to their craft. A model of physician conscience is proposed that summarizes the best features of both models--paternalism and autonomy.