Medical Paternalism: Definition & Ethics

Instructor: Ian Lord

Ian is a real estate investor, MBA, former health professions educator, and Air Force veteran.

Medical paternalism isn't just an old-fashioned approach to medicine; it denies a patient the ability to make informed healthcare decisions. Let's define medical paternalism and explore the ethical implications of this treatment approach.

Medical Paternalism As Seen By the Patient

Brian's doctor just seems to have an old-fashioned approach to patient care. While the doctor might ask for his opinion on treatment, in the end it seems that his doctor decides what they are going to do. For Brian, this always seemed normal, but as he talks to his son, he realizes that this trend is changing. Brian's doctor practices a philosophy of medical paternalism. In this lesson we will look at what medical paternalism is and the ethical considerations surrounding it.

Definition

Medical paternalism is when the doctor interferes with the patient's ability to make a choice regarding their healthcare. This can take many forms on a spectrum of intensity. Brian's doctor listens to him, but doesn't do much in the way of offering him a choice of treatment options or attempts to gain consent. In extreme cases, a doctor might even lie or exaggerate the consequences of not following the plan of action to motivate the patient to comply.

Doctors aren't usually trying to be malicious or evil; their intent is to help the patient. The issue is when doctors believe they alone know the best course of action. They do not trust the patient to make an informed decision regarding his or her healthcare. Many of these doctors question how anyone can make an informed decision without having a medical education. This brings us to the ethical implications of paternalism in medicine.

Ethical Considerations

The ethical debate surrounding medical paternalism has led toward a trend in medicine of greater patient involvement in healthcare decisions. Paternalism has largely been seen as something that older doctors 'set in their ways' do. Although most patients like Brian have neither been to medical school nor have comprehensive experience with healthcare, most patients are able to understand, select, and comply with treatment if given understandable and appropriate information by providers.

The problem with a general paternalistic approach is that it dehumanizes patients by taking away their right to an honest assessment of their health and an informed consent with regard to treatment options. Denial of information or outright lies and manipulation removes the patient's opportunity to say no and their ability to fully understand the possible outcome. We have no reason to suspect Brian is incapable of making an informed decision and must be manipulated into medical treatment compliance. Even if paternalism had dramatically improved outcomes, does the end justify the means?

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