Abstract
Professional autonomy, as the symbol of the traditional freedom ofdecision-making of medical professionals is criticized. This essayexamines the critique. It analyses the underlying assumption that theautonomy of health professionals is incompatible with the need fororganisation and management in order to control rising health carecosts. It is argued that the concept of professional autonomy should beredefined, not through restricting the decision-making freedom ofindividual health professionals, but through expanding the concept intothe sphere of management, so that managers will take responsibility forpatient care.
Similar content being viewed by others
REFERENCES
Brody H and Miller FG. The internal morality of medicine: Explication and application to managed care. Journal of Medicine and Philosophy 1998; 23(4): 384–410, at 388.
Brody and Miller: 388.
Chervenak FA and McCullough LB. The threat of the new managed practice of medicine to patients' autonomy. The Journal of Clinical Ethics 1995; 6(4): 320–323.
Dupuis HM. Professional autonomy: A stumbling block for good medical practice. An analysis and interpretation. This issue.
Government Committee on Choices in Health Care. Choices in Health Care. Rijswijk: Ministry of Wellfare, Health and Cultural Affairs, 1992.
Howe EG. Managed care: “New moves,” moral uncertainty, and a radical attitude. The Journal of Clinical Ethics 1995; 6(4): 290–306.
Klazinga N, Schepers R. Tussen eenheid en verdeeldheid. Medische specialisten in Nederland sedert de jaren negentig [Between unity and division. Medical specialists in The Netherlands since the nineties]. Gezondheid 1996; 4(1): 16–29.
Ladd J. The internal morality of medicine: An essential dimension of the patient-physician relationship. In: Shelp EE, ed., The Clinical Encounter. Dordrecht: Reidel, 1983: 209–231, at 212.
Ladd J. The good doctor and the medical care of children. In: Kopelman LM, Moskop JC, eds. Children and Health Care: Moral and Social Issues. Dordrecht: Kluwer Academic Publishers, 1989: 281–302.
Manschot H. —Is zorg een produkt of een relatie? Kritische kanttekeningen bij de economisering van de gezondheidszorg [Is care a product or a relation? Critical comments to the economization of health care]. In: Pijnenburg MAM, ed. Zakelijke zorg-zorgelijke zaak? 's-Hertogenbosch: KVZ, 1994: 36–43.
Manschot H, Willigenburg T van. —Ethiek en levensbeschouwing: een aandachtsgebied voor het management [Ethics and worldview: A management concern]. In: Pijnenburg MAM, ed., Denken over zorg. Zorg over denken, Baarn: Gooi en Sticht, 1992: 57–67.
Pellegrino ED. Interests, obligations, and justice: Some notes toward an ethic of managed care. The Journal of Clinical Ethics 1995; 6(4): 312–317.
Pellegrino ED. The commodification of medical and health care: The moral consequences of a paradigm shift from a professional to a market ethic. Journal of Medicine and Philosophy 1999; 24(3): 243–266.
Peursen CA van. Het nieuwe management. Ontwikkelingen binnen een veranderende cultuur [The New Management. Developments in a Changing Culture]. Kampen: Kok Agora, 1996.
Pijnenburg MAM, ed. De achterkant van de organisatie. Management, cultuur en ethiek in de gezondheidszorg [The Backside of the Organisation. Management, Culture and Ethics in Health Care]. Assen: Van Gorcum, 1994.
Rijksen WP, ed. Ondernemend besturen. Ziekenhuismanagement van overmorgen [Enterprising Management. Hospital Management for the Day After tomorrow]. Assen: Van Gorcum, 1996.
Satz AB. Do we really want doctors to be managers? Health Care Analysis 1996; 4(1): 80–84.
Schepers R, Klazinga N and Scholten G. Beter maten dan managers. Managementparticipatie in de Nederlandse ziekenhuizen [Better mates than managers. Management participation in the Dutch hospitals]. Gezondheid 1996; 4(1): 30–38.
Sulmasy DP. Managed care and the new medical paternalism. The Journal of Clinical Ethics 1995; 6(4): 324–326, p. 325.
Willigenburg T van, Verweij M, Kleemans CHM, Kloot Meijburg HH van der. Ethiek, levensbeschouwing en het management in instellingen voor intramurale gezondheidszorg [Ethics, Worldview and the Management in Intramural Health Care Institutions]. Utrecht: Nationaal Ziekenhuisinstituut, 1991.
Zoloth-Dorfman L, Rubin S. The patient as commodity: Managed care and the question of ethics. The Journal of Clinical Ethics 1995; 6(4): 339–357.
Zoloth-Dorfman and Rubin: 341.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ten Have, H. Re-Evaluating Professional Autonomy in Health Care. Theor Med Bioeth 21, 503–513 (2000). https://doi.org/10.1023/A:1009933624853
Issue Date:
DOI: https://doi.org/10.1023/A:1009933624853