Who determines the course of a patient's treatment?
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* Paul C.S. Hoaken

In his review of Benjamin Freedman's *Duty and Healing: Foundations of a Jewish Bioethic*, David Novak refers to Freedman's consideration of the issue of informed consent.1 To say that physicians have a duty to inform patients of their reasonable options (leaving aside the lack of specificity of the term “reasonable”) does not mean that patients have the right to determine the course of their own medical treatment. Patients certainly have the right to choose from among treatment options of equal value that are consistent with their goals; they also have the right to refuse all options. However, they do not have the right to dictate to their physician how they will be treated, as so many patients try to do nowadays, coming to the office laden with Internet printouts and magazine articles.

Freedman obviously had greater faith in the wisdom of patients than I do. Novak says that Freedman “speaks of the patient as ‘a responsible steward of his or her own body’ and of patients as ‘prudent caretakers.’” The prevalence of obesity and smoking and the general lack of physical fitness in Canada force me to conclude that this statement represents the triumph of Freedman's idealism over empiricism.

## Reference

1.  1. Novak D. Reading Freedman [book review]. CMAJ 2000;163(5):577-8.
    
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