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Fostering empowerment: ethical, political, and practical considerations.

That patients should be empowered can appeal to both doctors and patients. Empowerment is defined as making the balance of power between the doctor and the patient more equal.1 Like many exacting concepts in health care, empowerment has both ethical and political aspects.

The ethical aspect arises because imbalances of power can lead to coercion of the weaker individual or group by the more powerful. The more equal in power individuals or groups are, the less the risk of coercions. Ensuring that patients are free from coercion, through respect for their autonomy, is a professional ethical value for doctors.2 But respecting patients’ autonomy can be difficult. Doctors may not see that some of their actions, carried out with good intentions, infringe patients’ autonomy. Lack of time to discuss possible courses of action, pressures to prescribe specific interventions, or belief that patients do not want to engage in discussions about their treatment can get in the way of fully respecting patients’ autonomy.

The political aspect of empowerment is more complicated. Power, the ability to get things done in the power holder’s interests, can move from person to person or from group to group, depending on the circumstances.3 The balances of power within individual doctor–patient clinical relationships can change from doctor to doctor, patient to patient, moment to moment. Equality of power can be seen in action when doctor and patient each respect the other’s autonomy, and esteem each other as their equal in human worth and in voice. Then doctors can encourage patients to speak from their own sense of agency and their sources of knowledge, just as the doctor does, from their knowledge and sense of agency. Both can contribute information and express their preferences, interacting with mutual influence and shared power to reach a decision that …