Patient autonomy, paternalism, and the conscientious physician

This paper concerns itself with the concept of diminished competence with particular regard to the problems and options that mentally compromised patients raise for medical management. It proceeds through three general stages: (1) a restatement of the sense and grounds of the new patients' rights ethos which the existence of such patients calls into question; (2) a consideration of what expanded responsibilities and tactics physicians should embrace to protect and enhance such patients' autonomy; and (3) the standards, criteria, and mechanisms by which paternalistic interventions might be justified in cases when the diminishment remains too substantial to merit acceptance of the patients' directives.