Paternalism in Health Care

Paternalism in Health Care

Physicians dedicate their lives to benefiting the lives of others and dedicating their existence to bettering the health field. The Merriam-Webster dictionary describes a physician as somebody skilled in the art of healing, particularly: educated, clinically knowledgeable, and certified to practice medicine. The physicians’ role in healthcare is not only to treat the patient but also to provide education to guide them on making critical medical decisions. When a physician takes on a paternalistic role, the patient’s Autonomy may not be considered; however, I believe that in certain circumstances, this may be an ideal situation. In my opinion, paternalism is not always wrong, and in some cases, it is morally permissible for physicians to act paternalistically towards the patients in their care.

While it can be argued this fails to show adequate respect for the individual’s Autonomy, some people do not have the cognitive ability or educational background to understand what is an excellent decision to make for their health. The concept of paternalism is defined as the overriding of the decision making or actions of an individual for the person’s best interest. It is essentially the same thing as having the ability of choosing one’s own decisions or being in control of oneself. In contrast, Autonomy is defined as somebody’s rational capacity for self-determination or self-governance. Medical paternalism is not always wrong; it is actually a necessity in some situations. Situations such as are categorized under weak paternalism which is the act of paternalism towards those who cannot act autonomously themselves (Vaughn, 2013, 72). An example of this is an individual that has a developmental disability. In this case, I believe, overriding one’s actions or decisions, is beneficial to one’s wellbeing. For example, if someone who has a developmental disability is experiencing abdominal pain due to a hernia, a physician would recommend surgery if it was serious enough. The individual who has the developmental disability may cognitively not be capable of comprehending the severity of the hernia and may not want to undergo surgery. If the hernia was serious enough to be causing a life-threatening bowel obstruction, the physician would have to thoroughly explain to the individual and whoever the care provider is why the individual must undergo surgery in order to prevent further complications or even possible death. As stated by Ackerman in “At times, true respect for autonomy may require the physician to intervene, to deviate from the patients stated preferences” (Vaughn, 2013, 99).

In situations where a physician is overriding a patient’s decision due to the fact the patient is doing something harmful to themselves and the physicians choosing to guide the patient to enhance their health, paternalism has many benefits. Another example of a physician acting in a paternalistic manner that would be beneficial to the patient is towards a patient is towards uneducated individuals. It does not mean a physician should be making all the decisions for someone uneducated, but to respectfully guide an uneducated individual to the right decision if there is one is certainly acceptable. In some cases, a patient may not be knowledgeable or confident enough to make an important medical decision; therefore, they would rely on their physician to do so. For example, if an adolescent patient with no guardian sees their physician for an unplanned pregnancy, they may not have the proper knowledge of the health field, such as proper prenatal care. It is the physician’s responsibility to educate that patient in a paternalistic matter in order to ensure the safety of the unborn fetus as well as the mother. Perhaps the young mother to be is unaware that cigarette smoking is harmful to their child or is unaware of the negative effects of alcohol; these acts could result in birth defects or even death to the fetus. When there are lives’ at risk, paternalistic medical care is vital.

There are many cases when medical paternalism is situational a necessity at times. In keeping with XXX, strong paternalism is overriding actions or choices of a person despite the fact that the person may be substantially autonomous, defined within Vaughn’s text (2013,72). Strong paternalism may fail to respect another person’s Autonomy, but it depends on the situation at hand. If a physician is overriding a patient’s decision on the brand of the same type of blood pressure medications, then that is failing to respect the patient’s Autonomy. This is because if each brand of blood pressure medication has the same positive results then the patient should be able to have the option to choose, rather than the physician pushing towards a decision. On the other hand if a physician is discontinuing filling a patient’s pain killer prescription due to the fact the patient has been abusing them and talking about committing suicide, then strong paternalism is needed. The patient abusing the painkillers is not respecting their own Autonomy, and the physician, discontinuing the refills for the painkillers is respecting the patient’s overall health and wellbeing, even if it is not what the patient wants. Paternalism is morally acceptable, especially when it is saving the patient’s life. Another example would be when a physician is applying pressure on a wound that is severely bleeding in order to prevent the patient from losing too much blood. The patient may not want to have their wound touched at all, but when it is a life or death situation, the physician has to make the moral decision to save the patient’s life.

There seems to be a grey area for types of paternalism having to do with medical futility, or the alleged uselessness of administering particular treatments (Vaughn, 2013, 75). For example, Robert Schwartz states that physicians are not obligated to give scientifically ineffective treatments. More importantly, they are not required to provide treatment that is outside the scope of medical practices. For example, surgical amputation of a limb for purely religious reasons would not be a moral obligation (Vaughn,2013,104). In the text, the story of Helga Wanglie is highlighted after she was hospitalized after tripping on a rug and fracturing her hip. Helga ended up needing assistance breathing and was also put on a ventilator. As the months went on, Helga remained in a vegetative state and was receiving round the clock life-sustaining treatment such as tube feedings and antibiotics. As her condition progressively deteriorated, she was evaluated by two teams of physicians who came to the conclusion that the treatment she was receiving was no longer beneficial to her condition and would not ease her suffering and would also repair her body in any way. The family of Helga was distraught over these findings and refused to stop the treatments. This resulted in a court case to rule the fate of Helga’s treatment. Unfortunately, three days after the court ruling, Helga passed away due to natural causes. Even though multiple teams of physicians agreed on the treatment Helga was receiving was futile, the family was not accepting of the physician’s recommendations. In my opinion, the physicians were in the right to act paternalistically because they had the knowledge and clinical experience to understand the treatment was ineffective and they were respectful to the family by attempting to explain this to them. The physicians went to the extent of trying to relocate her to a different hospital to receive care. In this case, the physicians were morally correct in how the situation was handled because although the patient could not make decisions for herself, the physicians still listened and respected the family’s views.

It is not only acceptable, but a physician’s job to act in a paternalistic manner depending on the situation. If the physician is truly abiding by the best interest of the patient’s overall health and respecting the patient as a person, I believe the Autonomy of the person is completely respected. If a patient is coming to a physician for guidance in a field that is unknown to them, which is why the patient is going to the physician in the first they should trust the physicians advice and guidance. The physician is guiding the patient in the direction that is most beneficial to the patient’s health. It does not mean the physician solely takes on the position of making all decisions for the patient, but it means to guide the patient and educate the patient to the best of their ability. Physicians who act paternalistically do not fail to show adequate respect for their patient’s Autonomy if the physician is truly giving their best-cultured advice to better the patient’s wellbeing. The physician should not solely make the decisions for the patient but should educate the patient on the situation and make the recommendation towards the most favorable outcome. The patient should be the one making the final decision for themselves, with the guidance of the physician in their field of expertise.