Who determines the course of a patient's treatment?

I n 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. A s a medical adviser for the Associated Jehovah's Witnesses for Reform on Blood, I would like to challenge some statements made by Zenon Bod-naruk in his response 1 to John Doyle's letter regarding Jehovah's Witnesses and artificial blood. 2 Bodnaruk states that our Web site (www.ajwrb.org) " purports to present the position of Jehovah's Witnesses. " This is incorrect. The site does not represent the position of Jehovah's Witnesses in general, but rather the dis-senting views among Witnesses regarding this controversial policy. 3 Bodnaruk is also not completely correct in saying that " individual members make their own personal decisions with respect to fractions of blood components " and that this is " the long-standing position " of the religion. Official church publications show that the use of serum was prohibited by the church from 1964 to 1973, the use of clotting factors by hemophiliacs was prohibited until 1978 and the use of al-bumin was forbidden until 1981. More details of the history of the blood policy are available at our Web site, with references to Watchtower Society literature. The total reversal of the policy surrounding the use of hemoglobin in only 2 years, …