Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship: Attitudes among Norwegian physicians

Sixteen statements on physician attitudes in the physician-patient relationship were presented to a representative sample of Norwegian physicians (N=990). Three moderately correlated theoretical dimensions were identified in a principal component analysis: paternalism, patient autonomy, and moral deliberation. The paternalism scores increased significantly with age, and psychiatrists scored significantly lower than physicians in somatic specialties. Psychiatrists had the highest scores on the patient autonomy dimension, whereas surgeons scored the lowest. Moral deliberation scores increased slightly with age. To explore the pattern of scores across the three dimensions, the scores were dichotomized and combined in eight different ways. The resulting typology included five different physician profiles: (1) classical paternalists (high scores on paternalism, low scores on both patient autonomy and moral deliberation), (2) modern paternalists (high scores on both paternalism and deliberation, low scores on patient autonomy), (3) autonomists ( high scores on patient autonomy, low scores on both paternalism and deliberation), (4) deliberationists (high scores on deliberation and patient autonomy, low scores on paternalism), and (5) ambivalents (high or low scores on all dimensions, or high or low scores on both paternalism and patient autonomy). The four groups of physicians with 'consistent' attitudes contained between 12 and 19% of the total sample, whereas 37% belonged to the 'ambivalent' group. Laboratory doctors and surgeons belonged significantly more often in the group of classical paternalists than did general practitioners, whereas male physicians were more often modern paternalists than were female physicians. Among the autonomists, women were more numerous than men, doctors in their 40s clearly more numerous than those in their 60s, and psychiatrists clearly more numerous than residents.