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Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients’ and physicians’ views
  1. A M Stiggelbout1,
  2. A C Molewijk1,
  3. W Otten1,
  4. D R M Timmermans3,
  5. J H van Bockel2,
  6. J Kievit1
  1. 1Department of Medical Decision Making, of the Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Surgery of the Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Social Medicine of the Free University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to:
 Dr A M Stiggelbout
 Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden;


Objectives: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.

Methods: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.

Results: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.

Discussion: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles.

  • patient autonomy
  • psychometrics
  • physician-patient relations
  • questionnaire
  • empirical ethics

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  • * The authors viewed the fourth model—the interpretive model—to have limited relevance for medical consultations as compared (for example) with psychotherapy.

  • In our pilot study, we had used the term “your ideal of the patient-physician relation”, but this turned out to be too abstract for the patients. After thorough discussion we decided to use the term “good relation” instead, with the qualifications as given above (Molewijk AC, unpublished data).

  • Supported by a grant of the Netherlands Council for Scientific Research NWO.

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