Attitudes and practices of patients and physicians towards patient autonomy: a survey conducted prior to the enactment of the Patients' Rights Bill in Israel.

On the surface, it would appear that patients would welcome the opportunity to relinquish their traditional subordination to doctors in therapeutic decision making, and that doctors would be pleased to have partners with whom to share the burden involved in making such fateful decisions. We investigated the attitudes and practices of patients and physicians towards "patient autonomy" in an outpatient clinic of an internal medicine department prior to the enactment of the Patient's Rights Bill in Israel. There were 81 patients randomly chosen from those attending the study clinic and 21 physicians randomly selected from among the physicians treating them. They were all administered the Krantz, the Abramson Health Index, and the Christie Ethical Decision Making pre-tested questionnaires. They were also queried on demographic and background material. The results indicated that the patient sample was neither particularly interested in participating in medical decision making (average score of 3 out of 9 in the Krantz behavioral involvement sub-scale) nor in receiving medical information (average score of 4 out of 7 in the Krantz preference of information sub-scale). The physicians exhibited a willingness to establish equal relations with their patients, and claimed to prefer their taking an active role in decision making. However, when presented with ethical dilemmas, the physicians were not consistent in their attitude in terms of respecting "patient autonomy." The findings of an Israeli survey conducted three years after the bill's passage showed that only one-third of the studied physicians had read the Israel Medical Association booklet's explaining the new law and most of them claimed that the new law had no affect on their daily encounter with patients, meaning that the law did not affect any change in these physicians' pattern of behavior. We concluded that if the Patient's Rights Bill is to achieve its goals, it will have to be accompanied by a widespread educational campaign to encourage the public to appreciate the value and the importance of the autonomy granted to them, and to guide them in exercising this autonomy to its best advantage. In parallel, the medical profession will need to be aware of the importance of achieving the therapeutic goals while upholding ethical and moral values in health care.