The growing consensus that patients ought to be more involved in their own care lies at the con- fluence of several powerful ideas. Political trends, thinking on ethics, and research on health services have all contributed. As experienced consumers, patients understand that they have rights, and they are much less inclined than they used to be to leave medical decisions entirely to the experts. Ethicists have by and large accepted the principle that autonomy (what the competent, informed patient wants) trumps beneficence (what the doctor thinks best for the patient) in all but the most extreme circumstances. In addition, there is evidence that the expanding involvement of patients in care produces better health outcomes, providing an empirical rationale for what may have been an inevitable shift in power and social control.
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