Ethics of medical paternalism

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Mon Apr 26, 2021

Medical paternalism is an approach where the physician makes decisions in a medical situation by overriding the patient's decision. 

Physicians may view requests from these patients as impractical, unjust, or even harmful from a professional point of view and may feel they are being asked to give inappropriate or futile care, as most patients do not have enough knowledge about healthcare processes to make calculated decisions. Most decisions about medical processes are made unilaterally by physicians when it comes to requirements such as blood tests and scans, whereas elective surgeries are generally the patient's choice. 

It can be a tough call to make when it comes to ethics behind who gets to make the final call with medical procedures. Paternalism was then categorized into varying degrees of control models.

Activity—passivity refers to the traditional version of paternalism, in which the doctor treats the patient as one who cannot or should not make decisions. This relationship is similar to that of a parent and child. Treatment is performed "irrespective of the patient's contribution and regardless of the outcome." This model is considered justified in emergencies in which there is no time to consider the patient's preferences or contributions.

Mutual participation involves the physician making it clear that they are not infallible and does not always know what is best. This model is more of a partnership, in which the doctor helps the patient to help themself. This model is often employed in cases of chronic disease or pain, in which the patient can have a higher degree of freedom and be more independent of the doctor.

Paternalism can often cause legal issues as, if the physician decides to abide by the patient's wishes in a more chronic or life-threatening situation, it could be considered malpractice. The issue here is the question: where should the physician draw a line when it comes to giving the important information? This can particularly be more difficult in the case of euthanasia. Even though it might be the patient's wish to die, perhaps in the diagnosis of having to live with constant pain, it is reasonable for the patient to request to be euthanized, but is it ethical for the physician to support this decision?

As a community that has taken an oath to protect, are physicians still protecting their patients by protecting their wishes, or is their knowledge of what can save a life more important than the patient's control over their life? The practice of physician-controlled decision making is a lot more prevalent in the medical field than we notice. The physician is essentially trying to do what is best for the patient against the patient's will. Paternalism is inherent in the physician's role.

From the 18th century, it was considered that the physician's decision was the most important. The transition to allowing more patient-centric decision-making started in the 20th century.

Selective paternalism or shared decision making (SDM) is an ethical framework where the experience and the knowledge of a physician, as well as the patient's autonomy, are respected. This made patients more human, rather than just a list of symptoms to be treated, making the treatment more personalized and giving better results. The physician usually does not overrule the patient's decision, even if they disagree with it, as long as the patient is sound of mind. It is difficult to restrict the physician and the patient's authority.

The SDM method uses the allocation of elements in decision making (with the patient's religious, moral, and ethical ideologies in mind) that each party represents and comes to a collective conclusion through analysis of various solutions. SDM in conclusion is an effective method that helps physicians exercise the essential element of patient autonomy and implement the highest level of ethical practice. 

 

 

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2021 - Spring - Issue 11
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