 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Simon N. Whitney, MD, JD, Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, (713) 798-3634, swhitney@bcm.tmc.edu, Amy L. McGuire, JD, Institute for the Medical Humanities, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, and Laurence B. McCullough, PhD, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
Paternalism occurs when a person with superior knowledge or power overrides the will of another in order to promote the other's welfare. Paternalism in the medical context includes physicians who withhold treatment from patients who want it or coerce patients to undergo undesired treatments. Withholding information is also a paternalistic act, as is forcing undesired information on the patient. Paternalistic actions may be morally justified or unjustified.
We distinguish fact-paternalism from value-paternalism, based on whether the patient is mistaken on the facts or is pursuing values that differ from those of the physician. We also distinguish means-paternalism from end-paternalism. A physician is better positioned to evaluate a patient’s interpretation of the facts than her values, and is similarly better positioned to criticize a patient’s preferences regarding means than her choice of goals. A decision to override a patient’s value-based or goal-directed desires (such as the refusal of blood for religious reasons) is rarely justified.
Paternalism also pervades institutional and government policies. The restriction of drugs to use by prescription is largely fact-based. Facts and values, means and ends may be intertwined, as is the case with motorcycle helmet laws. Finally, it is possible for government paternalism to be both value-based (promoting a specific set of moral standards) and factually incorrect, as may be the case with withholding information about condom use and HIV prevention. Government paternalism may be justifiable when it is fact based, but the government is never justified in promoting a position that is scientifically incorrect.
Learning Objectives:
Keywords: Ethics, Decision-Making
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.