The history of medical paternalism: from Hippocrates to Percival
- Topic
For centuries the doctor decided for the patient and hid the truth «for their own good»; that tradition only began to change in the 20th century.
What it is
Medical paternalism is the idea that the doctor, who knows, decides for the sick person, who obeys. It was not an isolated abuse: it was the official ethics of medicine for more than two thousand years. The Hippocratic writings advised concealing from the patient almost everything being done and not revealing the prognosis. In 1803 the Englishman Thomas Percival published Medical Ethics, the first modern code, which asked the doctor to be «the minister of hope and comfort» and to avoid gloomy prognoses; the American Medical Association adopted that code in 1847. The change came in the 20th century with informed consent and patients' rights: in 1961 about 90 % of the doctors in a US survey preferred not to disclose a cancer diagnosis, and in 1977, 97 % preferred to disclose it. The «Paternalism» page explains the types (soft and hard); this one tells its history.
Key facts
- Classical Greece: the Hippocratic treatise Decorum advises attending calmly, turning the patient's attention away from what is done, and not revealing their present or future condition, because «many» take a turn for the worse.
- The Hippocratic Oath promises to act for the benefit of the sick and to keep secrets, but says nothing of the patient's will or consent.
- Middle Ages and early modern period: the tradition passes through physicians and religious moralists; the sick owe obedience, and the good patient's virtue is trust.
- Percival wrote his code to settle a conflict among the doctors of the Manchester Infirmary (1789–1792); he circulated it in 1794 and published it in 1803.
- Percival asked doctors not to be forward with gloomy prognoses, to warn the patient's friends of danger, and the patient only if absolutely necessary.
- 20th century: Nuremberg (1947), the US consent cases and the patients' rights movement shift the model towards shared decision-making.
From paternalism to shared decision-making
| Period | Who decides | What the patient is told |
|---|---|---|
| Hippocratic tradition | The doctor | Little: the prognosis is hidden so as not to discourage |
| Percival (1803) and AMA (1847) | The doctor, with a kindly manner | Hope and comfort; bad news goes to the family |
| Mid-20th century | The doctor, increasingly questioned | A serious diagnosis is usually hidden (1961 survey) |
| From the 1970s | The informed patient, with the doctor | The truth, with tact and according to what the patient wants to know |
In clinical practice
- When a family asks to «tell them nothing» about a capable patient, it repeats Percival's model; today the rule is to talk with the family first and then respect the patient's right to know.
- Saying «it is for their own good» is not enough to justify concealment: a serious, concrete harm must be shown, as in therapeutic privilege, which is a narrow exception.
- The paternalist tradition left one virtue that still holds: care for the patient's spirits. The tact is kept and the deception dropped.
- Recognising the paternalist legacy helps spot phrases like «just sign here, it's a formality», which empty consent of meaning.
Legal framework in Colombia
- Law 23 of 1981, art. 15: the doctor asks for the patient's consent for treatments that may affect them, and explains the consequences beforehand.
- Statutory Law 1751 of 2015, art. 10, item d: right to clear, appropriate and sufficient information to decide; no one may be forced to receive treatment against their will.
- Official texts checked on 2026-11-13 at funcionpublica.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
What did the Hippocratic treatise Decorum advise about informing the patient?
To attend calmly while concealing most things from the patient and not to reveal their present or future condition, because many took a turn for the worse on learning it.
What did Thomas Percival publish in 1803, and what was its influence?
Medical Ethics, the first modern code of medical ethics, written in Manchester; the American Medical Association adopted a code based on it in 1847.
How did Percival describe the doctor's role with a seriously ill patient?
As «the minister of hope and comfort»: avoid gloomy prognoses and warn the patient's friends of danger, and the patient only if absolutely necessary.
How did US doctors' attitudes to disclosing a cancer diagnosis change between 1961 and 1977?
In 1961 about 90 % preferred not to disclose it; with the same questionnaire, in 1977 97 % preferred to disclose it: a complete reversal of attitude.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Hippocrates, volume II: Decorum (translated by W. H. S. Jones) (Internet Archive (Loeb Classical Library edition), 1923); Greek Medicine: the Hippocratic Oath (translation by Michael North, 2002) (U.S. National Library of Medicine, 2002); Medical Ethics; or, a Code of Institutes and Precepts (Thomas Percival) (Project Gutenberg, 1803); Thomas Percival (Medical Greats collection) (University of Alabama at Birmingham Libraries, Reynolds-Finley Historical Library, 2026); Changes in physicians' attitudes toward telling the cancer patient (Novack DH et al., JAMA 1979;241:897-900) (Drexel University Research Discovery, 1979); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo, 1981); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Función Pública, Gestor Normativo, 2015).
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Representative model, for educational purposes only.