Ackerman and Goldman on Paternalism

Introduction

This paper aims to analyze two opposing views on medical paternalism by Alan Goldman and Terrence Ackerman and further explain why medical paternalism is not the right approach when treating a patient. To state briefly, Goldman opposed the idea of paternalism and was of the view that saving the life of the patient is the top priority of the medical professional and giving the patient freedom of choice is part of it, whereas, Ackerman suggested that the patient’s health including his mental health should be evaluated thoroughly before making any serious decisions about his health and certain situations. He also believed that during illness, patients were incapable of making a logical decision for themselves and the doctor must intervene and make the right decision.

Presentation of Topic

Paternalism is an idea or a practice that gives the people authority to restrict the authority of the dependent people involved for the sake of their well-being (Goldman, Pg. 63). This meant giving the sole authority of decision making to the medical professionals and letting them go through with any procedure they deemed fit for the sake of the wellbeing of the patient but the major argument that surfaced against this ideology was of patients’ autonomy, which gave them the right to make decisions about their medical situation (Ackerman, Pg. 74).

These two terms will be used repeatedly throughout this paper to make the argument as to why paternalism is not in the best interest of the patient, no matter what the medical situation of the patient is, he/she has the right to know about their condition, further options, and treatments they can get, but not giving them this right can have devastating outcomes.

In his journal article “The Refutation of Medical Paternalism”, Goldman stated that whether the doctors have the authority to make decisions in regards to a patient’s interest that they (the doctors) would otherwise lack if they were not the professional. It is a subconscious desire of the doctor to make decisions for their patients, although this desire comes from a good place, it does not mean that it is the right thing to do. Every individual prefers the freedom of making their own decisions and this freedom gives them a sense of security that makes them feel in control even in the most hopeless situations. During illness, a patient is already feeling vulnerable so if in that situation if the right to make their own decision is taken from them, even if it is in their best interest, it will make them fearful of their safety. If the decision made by a doctor turns out to be wrong, although well-meaning, it will not only cause overall harm but also resentment but if the same decision is made by the patient then they will trust their doctor’s diagnosis more.

Goldman argued that medical paternalism did not work as a physician does not have the knowledge about the medical history and priorities of every patient without having a personal relationship with every patient which is impossible and unjustifiable. A physician should communicate the true condition of the patients with them and allow them to decide for the further procedure themselves, as all individuals know themselves better than others and can make a decision that will serve in their best interest.

Contrary to this, Ackerman in his article “Why Doctors should intervene”, argued that patients do not have the rational capability and educated understanding to make decisions for themselves, thus it is in their best interest to leave the decision making to the doctors as they are well informed about the medical problem and much more capable of making the right decision. Giving the patient autonomous rights such as the right to refuse treatment, informed consent, privacy, and competent care can hinder the doctors’ treatment process. Ackerman further stated that the patients’ illness impedes their autonomy and makes them incapable of rational decisions. In such cases, the noninterference of a doctor will be unethical and it was a doctor’s job to bring a patient back to health and in their autonomous state. Ackerman further elaborated his reasoning by stating that many untimely deaths have occurred due to patients’ making a wrong decision, fear, guilt, or their lack of faith in science putting religion before their well-being. Sometimes patients make decisions that do not align with their life goals and in those times the doctors should intervene and override the patients’ decision by doing what they feel is right for the patient.

Arguments made by Goldman seem logical as he insists on putting the wellbeing of the patient first as he believes that patients know about themselves better than the others and a physician cannot possibly; have deep knowledge of the medical history of every patient he/she treats so respecting the patients’ decision will help treat the patient. This not only preserves the patients’ rights to autonomy but also makes them feel secure, further benefiting the physician as the patient will develop trust in his doctor.

In contrast to this Ackerman’s argument seems weak as he is biased towards doctors, fails to recognize the importance of other staff such as nurses, volunteers, etc. His point of view makes the patients out to be incompetent individuals that cannot make any decision for themselves. He considers the input and concern of the family of the patient as unnecessary and a hindrance. On top of all this, he also thinks that not all doctors are credible. This type of disregard of a patient’s rights and deeply biased opinion about the competence of doctors is extremely arrogant and fails to see the greater benefits of letting the patient in on decision making. Thus, making it painfully obvious that medical paternalism is not in the best interest of the patients.

Received View/Reconstruction of Other’s Argument

In Goldman’s eyes, gaining a patient’s trust goes a long way in giving them medical treatment and makes the process easier for the physician. The key points of Goldman’s arguments are:

• The ideological theory of “value orderings”; defined as the order of one’s life priorities, and how medical paternalism fundamentally violates this doctrine.
• Every individual knows themselves better than the others so their decisions should be respected.
• Medical paternalism is justified in certain cases even for competent adults when assumed that the individual is acting against their interests, values, or true preferences (Goldman, 63).
• In the end, the wellbeing of the patient should be the top priority of the doctor.

Arguments made by Ackerman come from a place of concern for the patient’s wellbeing but his article is strongly biased towards the doctors and makes the patient look incompetent and helpless. His key arguments are:

• A patient that falls ill is not at their full rational capacity and thus this impedes their decision-making capabilities.
• Autonomous rights cause hindrance to the doctors in the treatment of their patients.
• Non-interference can lead to devastating outcomes for the patients.
• Doctors should intervene and make decisions that they think are best for the patient.

Your Analysis and Original Argument

Medical paternalism may be useful in some cases but in most cases, it fails miserably as its principles have a complete disregard of a patient’s interest. A doctor should always be forthright about the medical condition of the patients and allow them the freedom of making their own decision. A patient has the right to refuse, consent, or withdraw from the treatment, after receiving the diagnosis but the doctor also has to inform the patients of every possible outcome so the patients can make an informed decision. Withholding any information from the patients is a violation of their rights. In this regard, Goldman’s argument that people know what is good for them holds as we live with ourselves every day and in case of an illness would know what would have caused that illness. So disregarding a patient’s input in a diagnosis can bring negative outcomes and may cause resentment in a patient.

Consider and Respond to a Possible Objection

A relevant objection can be that the patient’s rights should not be the only factor in medical paternalism. Input and concerns of the family also play a big part in the patients’ decision-making as families are the support system for them. Allowing all the freedom to patients in making their own decision may lead to a wrong decision that may cost them their lives. In response to this objection, the answer is that doctors should gain the trust of their patients so the patients have faith in their diagnosis and will stick to the treatment plan made by their doctors. Doctor-patient trust is very important in treating the patient.

Conclusion

This paper analyzed two opposing views on medical paternalism, one by Goldman and the other by Ackerman, and then further explained the reasons medical paternalism failed. Goldman was in support of autonomy whereas Ackerman supported medical paternalism. Medical paternalism stems from a place of concern but its approach is wrong. Physicians should always inform their patients about their medical condition without keeping anything from them. They should allow the patient to make their own informed decision and gain their trust in doing so.

References

Alan Goldman, “The Refutation of Medical Paternalism”.  From Steinbock, London, and Arras (eds.)(2009):  Ethical Issues in Modern Medicine (7th edition), McGraw-Hill, pp. 62-70.

Terence Ackerman, “Why Doctors Should Intervene”.  From Steinbock, London, and Arras (eds.)(2009):  Ethical Issues in Modern Medicine (7th edition), McGraw-Hill, pp. 73-77