Abstract
Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the view of the patient as an individual person.
Similar content being viewed by others
References
Forder A Concepts in Social Administration — a framework for analysis. London: Routledge & Kegan Paul 1974 pp 119–139
Jones K, Brown J, Bradshaw J. Issues in Social Policy. London: Routledge & Kegan Paul 1978 pp 59–77
Susser M W, Watson W Sociology in Medicine 2nd Edition Oxford: Oxford University Press 1971
See Downie R S Traditional medical ethics and economics in health care: a critique. In: Medical Ethics and Economics in Health Care. Eds Mooney G, McGuire A Oxford: Oxford University Press 1988 pp 40–55
ten Have H. Ethics and economics in health care: a medical philosopher’s view. In: Medical Ethics and Economics in Health Care. Eds Mooney G, McGuire A Oxford: Oxford University Press 1988 pp 23–39
Downie R S op cit p 46
Beauchamp T L, Childress J F Principles of Biomedical Ethics. 3rd Ed Oxford: Oxford University Press 1989
Mill J S On Liberty Ed Acton H B London: J M Dent & Sons Ltd., 1980 p 223
Childress J F Who should decide? Paternalism in health care New York: Oxford University Press 1982
Feinberg J Harm to Self Vol. III of The Moral Limits of Criminal Law New York: Oxford University Press 1986
Beauchamp T L, Childress J F op cit
Benson H, Epstein M The placebo effect: a neglected aspect in the care of patients. Journal of the American Medical Association 232 (1975) 1225
Ernst E, Herxheimer A. The power of placebo BMJ 1996; 313: pp 1569–1570
Dahan R, Caulin C et al. Does informed consent influence therapeutic outcome? BMJ 1986; 293 pp 363–4
Balint M. The doctor, his patient and the illness. London: Tavistock Publications 1957
Holliday I The NHS Transformed. Oxford: Nuffield Press 1995
Holliday I op cit pp 15–16
This followed the publication of the Griffith’s Report, the report of a group chaired by Roy Griffiths, deputy managingdirector of the J Sainsbury supermarket chain. The report observed that "if Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge." Griffiths R. NHS Management Enquiry Report (the Griffiths Report). London: DHSS 1983
NHS Executive. Towards a primary care led NHS: An accountability framework for GP fundholding. Leeds: NHSE 1994
Department of Health The NHS Plan, Cmd 4818-I. London: The Stationery Office 2000
Department of Health NHS Direct a new gateway to healthcare. London: The Stationery Office 2000
This can be seen on the website www.nice.org.uk
Department of Health A first class service — quality in the NHS. London: The Stationery Office 1997
Coulter A, Paternalism or partnership? BMJ 1999; 319 pp 719–20
See Tudor Hart J A new kind of doctor. London: Merlin Press 1988
Secretary of State for Health Saving lives: our healthier nation Cm 4386. London: The Stationery Office 1999
Guadagnli E, Ward P Patient participation in decision-making. Soc. Sci. Med. 1998; 47 pp 329–39
Richards M A, Ramirez A J et al Offering choice of treatment to patients with cancer. Eur J Cancer 1995; 31A pp 112–6
Coulter A, Peto V, Doll H. Patients’ preferences and general practitioners’ decisions in treatment of menstrual disorders. Fam Pract 1994; 11 pp 67–74
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Limentani, S. From Paternalism to Managerialism: A Healing Shift?. Philos. of Manag. 2, 3–9 (2002). https://doi.org/10.5840/pom20022118
Published:
Issue Date:
DOI: https://doi.org/10.5840/pom20022118