The Argument FOR Paternalism
Oh no he didn’t! Yes indeed ‘autonomy’ is one of the pillars of medical ethics but I’m gonna have a wild shot at rooting for paternalistic healthcare instead.
Firstly, I would like to credit Jezza for writing his thoughts on the doctor-patient relationship. It is indeed quite an interesting read that I would recommend to anyone.
Back in the day, before any of us computer literate folk were born, there was the birth of a great idea in medicine. This idea would define the practise of medicine for many generations of doctors to come. The concept of paternalism in the doctor-patient relationship was the way many physicians preferred to do things in the past.
Today we’re not so inclined to let these nerdy doctors control our life. We as the patient have a right to our own treatment options! So much so that the doctor cannot ethically or legally force us to undergo life-saving therapy. Frank Vertosick in his acclaimed bestseller, When The Air Hits Your Brain, discussed a real-life situation where a pregnant lady had a brain tumour and was faced with the dilemma whether to abort and carry out treatment, or carry the baby to full term and die from the cancer. She, like all other dramatic stories, chose the latter.
First point: Patient autonomy is overrated. How often does your doctor want to do something to you that will not in the end benefit you? Sure, doctors do slip up, but compare an experienced practitioner of medicine and a layman with no medical knowledge, who’s likely to make a poorer judgement on a treatment option? Damn right there newbie.
Second point: Patient autonomy is overrated. In an ethical sense, patients deserve to know it all, decide for themselves etc. But this is accentuated in the legal field of play where failure to comply with these ‘rules of autonomy’ can get a doctor into serious malpractice suits. I believe it was an Australian court that first ruled against the Bolam principles; and it still doesn’t use the Bolam principles today with regards to ‘disclosure of information’. Legal action son, don’t mess around with those lawyers – their stand is clearly with ‘ethics’.
Third point: Patient autonomy is overrated. As a rough estimate taken from an irrelevant source published in an irrelevant era, I would say that about 90% of patients will comply with a doctor’s treatment suggestion. So what’s the big hoohah about patients now wanting their own voice? They’re just gonna listen up to the credentials in the end.
Fourth point: Patient autonomy is overrated. Talcott Parsons‘ sick role model says that sick people aren’t morally culpable for their illness, but as a clause, must do their best to improve their condition. Hence, I declare that patients not following best advice (from non-else than the doctor) are morally culpable for their declining state of health – this is antisocial behavior.
Fifth point: Patient autonomy is overrated. “It is an oversimplification and distortion of the
Western tradition to view respecting autonomy as simply permitting a person to select, unrestricted
by coercion, ignorance, physical interference, and the like, his or her preferred course of action
from a comprehensive list of available options.” (Emanuel and Emanuel) ‘Nuff said there..
Sixth point: Patient autonomy is overrated. In no other of the 4 models is the physician’s obligation so in line with the Hippocratic oath. I quote Emanuel x2 again, ‘physicians use their skills to determine the patient’s medical condition and his or her stage in the disease process and to identify the medical tests and treatments most likely to restore the patient’s health or ameliorate pain. Then the physician presents the patient with selected information that will encourage the patient to consent to the intervention the physician considers best’. The Hippocratic Oath states, ‘I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous’ as well as ‘Into whatever houses I enter, I will go into them for the benefit of the sick’.
As such, I lay down my case FOR the paternalistic model of the doctor-patient relationship. Please advise and comment.
N.B.: I do not actually believe this to be the best model, just some opinions of mine to stir controversy. 
References:
Jezza. (2007) The Last Resort – When Procrastination Becomes Sloth, Blogspot [Available online: http://jman-jezza.blogspot.com/2007/06/when-procrastination-becomes-sloth.html, Accessed: 23 June 2007]
Emanuel E.J. & Emanuel L.L. (1992) Four Models of the Physician-Patient Relationship, JAMA 267:2221-2226 [Available online: http://www.davidhildebrand.org/teaching/courses/fourmodels.php, Accessed: 23 June 2007]
The Oath of Hippocrates [Available online: http://www.imagerynet.com/hippo.orig.html, Accessed: 23 June 2007]
