Since the beginning of Western Medicine nearly 2500 years ago with Hippocrates, the essential ground rule for the professional relationship between patient and doctor has remained the same, namely the patient relies on the knowledge and integrity of the doctor. There has been a striking disparity of power in this relationship, very much in favour of the doctor. In recent years much has changed. Not only have there been huge advances in medical knowledge, but patients have themselves become more knowledgeable, mainly due to the internet and the establishment of voluntary bodies which disseminate information about the diagnosis and treatment of illnesses. As a consequence, the so-called paternalistic medical approach is slowly giving way to patient-centered medicine in which the autonomy of patients becomes increasingly important. This has inevitably led to some differences of opinion between patients and doctors. This book advances philosophical arguments in favour of patient autonomy and describes some of these differences of opinion as they arise in psychiatric practice. It includes chapters on various restrictions, especially compulsory detention, imposed on patients under the Mental Health Act, epistemic injustice, do-not-resuscitate orders and assisted suicide, in which the issues are discussed from both a philosophical and psychological perspective. The book will be of interest to all professionals and non-professionals who are interested in ethical dilemmas which often arise in psychiatry.

Steven Greer, M.D., F.R.C.Psych, graduated from the University of Adelaide and obtained his postgraduate training in psychiatry at the Maudsley Hospital, London. He was Reader in Psychological Medicine at Kings College School of Medicine, London, where he was a co-founder of Psycho-Oncology in the U.K. Subsequently, he was Director of the Cancer Research Campaign Psychological Medicine Group at the Royal Marsden Hospital, Sutton, Surrey. His principal research activities during the last 30 years have comprised psychological and psychobiological investigations of patients with cancer. Dr Greer has written extensively on psycho-oncology and has, together with his colleagues, developed a form of psychotherapy, based on cognitive-behavioural therapy (CBT), but specifically designed to improve the quality of life of patients with cancer. He was the one to introduce the term "fighting spirit" in the psycho-oncology literature. He emphasizes the particular debt he owes to his patients, who taught him about the personal meaning of cancer, about courage, endurance and despair, and about how death can be faced. He is Reader in Psychological Medicine, Institute of Cancer Research and Consultant Psychiatrist at St. Raphaels Hospice, Surrey, U.K.