Authority, Power and Autonomy in Medicine

Money, science, and technology have been important, but not enough to create and sustain the massive medical-industrial complex. A critical additional force – one responsible for almost everything civilization has accomplished – has been necessary. That force is authority.

Authority exists between parents and children, employers and employees, governments and citizens, and between health care providers and those seeking care. At its core, it is someone acting as suggested or directed by another where action would not otherwise occur. While they are two drums beating constantly in the background of civilization - one a staccato snare you willingly tap your feet to, and the other a bass drum struck on occasion with such force you feel the vibration and are compelled to move – authority and power are not the same. Power implies the use of force or coercion and authority voluntary acceptance. The medical-industrial complex has never had power, so society had to grant it authority. In other industries, this is the “right to sell”, and in medicine - this is the “right to treat”.

The medical-industrial complex was built on three pillars of medical authority – informational, technical, and moral. Informational authority implies it possesses knowledge laypersons cannot access or understand, technical authority technology laypersons cannot obtain or use and moral authority suggests healthcare providers are somehow divinely empowered. Medical authority has prevented individuals from actively participating in a more effective care model. However, the three pillars are crumbling.