Autonomy and paternalism in medicine.

The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied contexts. As neither autonomy nor paternalism has a current universally accepted meaning, their significance varies in both ethical and clinical discussion. Of the two, autonomy has moved further from its original moral context, to the extent that it often now signifies no more than a person's expressed intention. Paternalism, characterised as the antithesis of autonomy, is widely thought not to have any role in medicine. The transforming effects of illness, which may radically alter a person's decision making capacity, are commonly ignored.