Individual Autonomy and Medical Paternalism

The article presents results of analysis of balancing physicians’ paternalism, traditional for the medicine in general and Russian medicine in particular, with principle of patients’ personal autonomy. The analysis bases on the data, published in the scholar literature on the surveys of doctors’ attitude to the paternalism and autonomy, as well as on the organized by the author survey of doctors of N.I.Pirogov Clinic of High Medicine Technologies of St.Petersburg State University and in analysis of judicial practice in cases on informed consent. The author concludes, that innovative medical practice in Russia rejected paternalism, while the conservative part of health care system (military medicine) as well as the courts still support this approach. The vague and uncertain legislative requirements to the content and form of informed consent partly give grounds for this, but more general problem is that the courts do not apply constitutional provisions directly and even protect personal non-material rights of patients, violated in cases when doctors act without patient’s consent.