Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.

Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)

He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)


Gawande attacks the nearly sacrosanct concept of informed consent and one of its most important advocates, Jay Katz. In fairness to Katz, he does say in his book, The Silent World of Doctor and Patient (New York: Free Press, 1984), that patients do have the right to autonomously ask their physicians to make decisions on their behalf (although he also suggests that the proper response of the physician is to initially vigorously challenge such a request).

Gawande does not want to promote paternalism, just more, as he puts it, "kindness." He also suggests that just as doctors need to learn the art of medicine, patients, too, need to learn the art of being a patient--"you must choose wisely when to submit and when to assert yourself." (p. 90)

Primary Source

The New Yorker


Condé Nast

Place Published

New York


October 4, 1999

Page Count