Introduction
The opposition by many ethicists towards the principle of medical paternalism is severely faulty. When analyzed keenly, such an approach is not beneficial at all. Alternatively, the best approach should be to regulate medical paternalism in a way that gives the patients autonomy at certain times and denies them the autonomy when it is necessary. It is crucial that patients are asked to consent or refuse to the medications that doctors administer to them. However, there are some situations whereby giving patients the opportunity or chance to give consent has no foreseeable positive outcomes. At times, the patients are too ill to the extent that they cannot make informed decisions. Such times necessitate that doctors make decisions without the consent of the patients. Therefore, for in order to achieve the best health outcomes, a balance between medical paternalism and full doctor’s autonomy must be established.
Paternalism used to be considered as the best approach to handle patients. However, this approach is old-fashioned and outdated. Under such an approach, doctors and other physicians developed a parent-child relationship with their clients. Whenever they thought it necessary, the doctors hid the truth from the patients in cases where they thought this would be in the best interests of the patient. Apart from this, the physicians had the autonomy of dictating the type of treatment that patients would be subjected to without the patients playing any role. In a way, this approach was based on the fact that the doctor was the expert in the field and consequently. whatever they decided was unquestionably final. Whichever medicine they prescribed, the patients had to take it without any question or opinion. Although this approach was based on the patient’s best interests, there is a belief that such an approach is detrimental because it undermines the patient’s autonomy in making personal decisions (Thomasma 375).
The 20th century brought about a different relationship between the patient and the doctor. In this approach, the doctors freely shared their knowledge with the patients and informed them of the reasons as to why certain decisions have to be made. This is where the doctors played the role of an educator in guiding patients how to make relevant and necessary decisions about the illnesses they were facing. It was essentially geared towards promoting the autonomy of the patients in making decisions. Any administration of drugs by doctors was based on some form of consent from the patient. This seems to be the best approach as the rights of patients to make personal decisions are promoted.
In medicine, it would be a big risk to give the patients full autonomy to dictate what should be done to them (Thomasma 376). Illness and diseases play a role in impairing the autonomy as well as the ability to make informed or conscious decisions. From the perspective of medical ethics, the major concern is on the well-being of the patients, rather than the autonomy of the patients to make personal decisions. It would be against the medical values and the principles of doctors to base their actions on the consent of the patient even when it is clear that such patients are incapacitated from making sound decisions.
In medical practice, the patient’s autonomy is not taken as an essential constraint. It is through utilitarian reasoning that the well-being of individuals in the society is facilitated. From the moral point of view, paternalism is not wrong. What is considered to be morally wrong is taking an approach where a doctor may decide to maximize the welfare of the patient at the expense of their autonomy (ignoring their instincts and not giving them a chance to contribute to decision-making when they have the capacity to do so.)
Many opponents of medical paternalism argue that every person is responsible for their happiness and because of this, they are the best judges to their bodies (Thomasma 376). The personal autonomy to pursue happiness is regarded as a necessity in one’s life. However, there is a big risk in allowing persons to live according to their wishes, simply to attain happiness. For the collective well-being of the society and humanity in general, it is essential that such autonomy is limited.
The ethicists seem to base their arguments on actions rather than the results attained. Situations arise where patients are in difficult conditions to make judgments, requiring the doctors to make decisions and opinions based on their personal judgment. Personal autonomy contradicts with the provisions of medical paternalism, both of which play a significant role in defining a person. There is a limit to which autonomy has to be sacrificed for the well-being of the individual, even without their consent. In cardiac care units, for instance, it is a common practice that patients will be asked to make decisions as to what should be done to them. Important to note is the fact that at this time, patients are at their worst situations; frightened and sick. This may mean that they may not be thinking normally as they would if they were in a stable situation. In such circumstance, the patients could end up making bad and unintended decisions that they would not have made if they were in a stable situation.
A good example where medical paternalism supersedes personal autonomy is in patients who are under a Do Not Resuscitate order. There are times when patients are under this order, and the doctors are of the opinion that the present problem is transient. What happens if the doctor thinks that the patient can recover? Do they go ahead and override the Do Not Resuscitate order? The order means that the patient has given their consent that no further efforts should be done by the doctors in an attempt to save their lives. From a moral perspective, it would be unethical for the doctor to follow the order and leaving them to die because of the consent they had given earlier. In such circumstances, medical paternalism overrides personal autonomy.
Seeking the patient’s consent should strictly depend on the condition that the patient is in (Thomasma 376). For instance, it is a fact that the manner that a physician presents options to the patient may influence the perceptions that one may develop. It is unlikely that ethicists would give in to the demands of a patient who is against a treatment that is life-saving simply because he has autonomy and should decide what happens to their body. There is a dangerous balance of beneficence and patient autonomy. Doctors are encouraged not to harm patients. However, what should happen in case the patients want to harm themselves? Should doctors step aside and watch because they have to wait for the consent of the patients? The most important thing is that patients have to be guided although they have autonomy. This is the only way to balance between the two.
Works Cited
Thomasma, David C. "Telling the Truth to Patients: A Clinical Ethics Exploration." Cambridge Quarterly of Healthcare Ethics 3.03 (1994): 375-376. Print.
