Section I: Introduction
In literal terms, the act of paternalism refers to doing well for others but without their consent or knowledge. In the field of medicine, medical paternalism means to act for the well-being of a patient without his or her knowledge or consent. It happens in several ways, such as providing the patient with the best medical facilities by allocating the resources for him or her. It is a dominant way of conceiving the relationship between a patient and his physician. That’s why there has been a debate on adopting the method in the practical medical field.
However, there are arguments both against and in favor of medical paternalism. There are two main arguments against the topic. The first one lies in the roots of personal autonomy and the moral theory associated with it. This side of the debate is theoretically interesting, and at the end of the day, it makes the stronger side of the argument. The second argument is based on the grounds of paternalism itself. They first meet a paternalist on his grounds and then cut him off from it by proving his case wrong or defective. This side of the argument has some practical effect.
This paper is an attempt to study the case of medical paternalism. For this purpose, two articles from the desks of Alan Goldman and Terence Ackerman have been taken and studied. Both of these pieces of writing present different sides on the topic under discussion. The rest of the paper is designed as follows: Section II: Presentation of Topic, provides an insight of the discussion; Section III: Recap/Reconstruction of Received View(s), presents the views and key points of Goldman (2013) and Ackerman (2013); Section IV: Analysis, their views are analyzed as per the real world scenario; Section V: Consideration and Response(s), responds to their views as per the professional requirements of nursing; and Section VI concludes the paper.
Section II: Presentation of Topic
Medical paternalism means to act for the well-being of a patient without his or her knowledge or consent. It is a dominant way of conceiving the relationship between a patient and his physician. That’s why there has been a debate on adopting the method in the practical medical field. Goldman argues that deciding about his future is the most fundamental right of a patient. However, this right can be transferred into the hands of a doctor for the time being under extraordinary circumstances as long as he manages to keep his choices consistent with the long-term preferences of the patient (Goldman, 2013). On the other side, Ackerman argues that a person who has fallen ill or sick loses his rational capacity. Therefore, the patient’s autonomy is impeded, through one means or another, by this illness. He further argues that the intellectual ability and personal autonomy of the patient are hampered by psychological, social, cognitive, and physical constraints. Thus, a doctor must first resolve them and then provide information to the patient on the selected criteria (Ackerman, 2013).
Section III: Recap/Reconstruction of Received View(s)
Alan Goldman has presented a case in favor of the practice of medical paternalism in today’s world in his essay The Refutation of Medical Paternalism. He argues that there is a definite difference between the roles played by the patient and his or her physician in a medical facility (Goldman, 2013). In this scenario, the doctor acts in the interest of the patient by carrying out the treatment, but the doctor may do it without his immediate will. However, Goldman suggests that every person presumes that he is the best judge of his fate and that he enjoys the intrinsic value of the freedom of deciding for himself (Goldman, 2013).
Goldman further argues based on the foundation that deciding in self-interest is the fundamental right of every person. To support his argument, he has presented a scenario where an individual who intends to go to New York rides the wrong train accidentally. A passenger who knows about the original destination of that person pushes him off the train and gets involved in the forced act of paternalism for that passenger. However, it was the fundamental right of the passenger to decide to ride on that train, but that person forcefully got him off. In this way, the personal autonomy of the passenger is sacrificed only for a short while. According to Goldman, this illustration is an example of justified paternalism (Goldman, 2013).
Additionally, Goldman has also provided an example of a motorcyclist who does not wear a helmet for a thrill, and a paternalist must interfere in his way of styling to save his life (Goldman, 2013). He argues that sometimes the short term preferences of the people do not meet their long-term goals. Therefore, paternalism is justified in helping such people out. Overall, Goldman has revolved around only one assumption in his paper that deciding about his future is the most fundamental right of a patient. In his words, “the autonomous individual is the source of those other goods he enjoys, and so is not to be sacrificed for the sake of them” (Goldman, 2013). However, he has maintained the difference between ordinary and extraordinary cases and argued that medical paternalism is only justified in extraordinary cases (Goldman, 2013). To prove the out-of-ordinary circumstances, he makes the presentation of substantial evidence necessary (Goldman, 2013).
The other paper that is going to be discussed to shed light on various angles of medical paternalism is titled Why Doctors Should Intervene and is written by Terence Ackerman. This paper has its background in the revised 1980 AMA Principles of Medical Ethics. According to these principles, every patient must be dealt with fairly and honestly at all times. They also emphasize respecting the patient-doctor confidentiality while respecting the rights of the patients. According to this model, the noninterference of the doctor in the decision-making of the patient is completed by the personal autonomy of the same.
Autonomy refers to a person’s intellectual capacity for self-governance or self-determination. Ackerman argues that an individual who has fallen ill or sick loses his rational capacity. Therefore, the patient’s autonomy is impeded, through one means or another, by this illness (Ackerman, 2013). If the doctor stays in the role of noninterference under such a scenario, it means that he is unable to take into account the transforming effect of the patient’s sickness. Based on this argument, Ackerman concludes that a noninterfering doctor fails to show the right amount of respect toward his patient’s autonomy (Ackerman, 2013).
According to Ackerman, the first responsibility of a doctor is to resolve the underlying constraints of a patient (Ackerman, 2013). He argues that the rational capacity and personal autonomy of the patient are impeded by these constraints. He includes psychological, social, cognitive, and physical constraints in this list (Ackerman, 2013). After addressing them, the doctor must provide information to the patient regarding these constraints and thus help them make their final decision based on the selected criteria (Ackerman, 2013). Ackerman explains that doing this will assist the patient in restoring control over their lives (Ackerman, 2013).
Section IV: Analysis
Goldman argues that medical paternalism is justified under extraordinary circumstances. According to him, it must never impede the long-term preferences of a person. However, adopting this practice in the real world scenario means disclosing information to the patient, and it can lead to depression in him. Depression can cause long-term effects on a person and bring death quickly upon him. Similarly, he has failed to consider the imminent or immediate harm medical paternalism can bring into the life of a patient. Additionally, he has overly emphasized on the classification of the events in ordinary and extraordinary cases to justify paternalism. However, his stance on keeping the choice of the doctor consistent with the long-term preferences of the patient is welcomed and respected in the medical field as it puts ethical and moral limits on the practice of medical paternalism.
Ackerman’s argument in favor of the practice of medical paternalism is supremely biased towards the doctors as he presents them as superior to the patients. At the same time, he has failed to show his regard towards the significant and critical role being played by the other medical staff, such as nurses, volunteers, Child Life Specialists, etc. in saving the lives of the patients. They greatly assist in maintaining the patient’s profile at the medical facility and assessment of the needs for the same. Unarguably, Ackerman has looked at the patients being unable to decide for themselves without the assistant of the doctor. According to him, the doctor is required in the scene to provide the patients with an insight into the constraints and a handful of knowledge on the selected criteria to decide because their sickness or illness deprives them of their autonomy and rational capacity to do so. While keeping this stance in the discussion, Ackerman overlooks the role of the family members in the decision making of the patient. In fact, he has tried to present them as a factor hindering the process and prohibiting the patient from deciding for him. He has also overlooked the fact in his discussion that not all doctors are credible.
Section V: Consideration and Response(s) to at Least One Objection
Being a part of the nursing profession allows us to see the same things from a different or tilted angle. Based on the professional requirements of a nurse, Ackerman has presented a significant and critical logic. Medical paternalism is inevitable for providing therapeutic play in preparing patients for medical procedures. At the same time, this practice also allows medical professionals to divert their attention and cope with the sensitivities of the illness with all their energy. Medical paternalism also assists in restoring a sense of normalcy and comfort in the lives of the patients and plays a critical role in easing or eliminating anxieties and any potential stressors inherent in their conditions and the environment. The only setup in Ackerman’s argument is his failure to recognize and encourage the role of the medical staff other than the doctors.
Section VI: Conclusion
Goldman (2013) and Ackerman (2013) have argued on the topic of medical paternalism from two different angles. The latter has tried to maintain the supremacy of doctors over patients by giving the right to decide for them at one end while the former has presented a case to justify the practice of paternalism in the field of medicine in extraordinary circumstances. Unarguably, Ackerman has looked at the patients being unable to decide for themselves without the assistant of the doctor, but he has managed to present an important and critical logic for the nursing profession. The only setup in Ackerman’s argument is his failure to recognize and encourage the role of the medical staff other than the doctors.
Alan Goldman, “The Refutation of Medical Paternalism”. From Steinbock, London, and Arras (eds.) (2013): Ethical Issues in Modern Medicine (8th edition), McGraw-Hill, pp. 60-68.
Terence Ackerman, “Why Doctors Should Intervene”. From Steinbock, London, and Arras (eds.) (2013): Ethical Issues in Modern Medicine (8th edition), McGraw-Hill, pp. 71-75.