The post-Nuremberg period coincides with the growth of technology-based
medicine. Although the Nuremberg Doctrine provided the moral force for
transforming consent to medical treatment, the growth of technology
determined the direction of this transformation. The interval between the
advent of scientific medicine in the late 1890s and the rise of technological
medicine in the 1950s was a period with relatively few effective treatments.
The patient’s choices were usually limited to one treatment or no treatment at
all. Perhaps most important, fewer conditions had been medicalized.
Symptomatic disease, rather than laboratory values, drove patients to seek
In this context, patients expected physicians to make all necessary medical
decisions. This was an extension of the traditional paternalistic
physician–patient relationship. It was also a reasonable response. The decision
on treatment was based mostly on technical medical considerations. Without
the luxury of several effective treatments, the paternalistic model of medical
decision making did not deprive patients of meaningful autonomy.