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Paternalism and Patient Autonomy


Vaughn, Chapter 3 What Autonomy is: Autonomy is a person s rational capacity for self-governance Its value is expressed in the Autonomy Principle: Autonomous ... – PowerPoint PPT presentation

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Title: Paternalism and Patient Autonomy

Paternalism and Patient Autonomy
  • Vaughn, Chapter 3

  • What Autonomy is
  • Autonomy is a persons rational capacity for
  • Its value is expressed in the Autonomy Principle
  • Autonomous persons should be allowed to exercise
    their capacity for self-governance
  • Vaughn, p.51

Paternalism, Weak and Strong
  • Paternalism benevolent action irrespective of
    or even contrary to the wishes of the
  • The term paternalism comes from Latin, pater,
    meaning father fatherly.
  • As such, Paternalism is always a violation of
    patient autonomy, though it may be justified,
    depending on circumstances.

Paternalism, Weak and Strong
  • What paternalism is not
  • Stopping someone from harming others (sometimes
    called delegated police authority)
  • Overriding a patients wishes in order to benefit
    the hospital, doctor, nurse, etc.
  • Overriding the patients wishes when they
    conflict with the health care providers values

Paternalism, Weak and Strong
  • Strong Paternalism (sometimes called extended
    paternalism) overriding of a competent
    patients wishes
  • Weak Paternalism (sometimes called cooperative
    paternalism) overriding of an incompetent or
    doubtfully competent patients wishes (Vaughn
    differs a bit, p.52, paragraph 2 prefer ppt

Paternalism, Weak and Strong
  • Strong Paternalism overriding of a competent
    patients wishes
  • Is Strong Paternalism ever justified?
  • For government
  • To protect the rights of others
  • To protect an overriding state interest (is this
    the basis for prohibiting suicide?)
  • Are these technically paternalistic?

Paternalism, Weak and Strong
  • The government, however, has not authorized
    health care providers to use strong paternalism
  • -Garrett et al., p 41, paragraph 2 (Book is cited
    on slide 17 you do not need to retrieve this
  • Garrett provides
  • inability to know anothers values and
  • the possibility of multiple acceptable choices
  • as reasons to reject strong paternalism.

Paternalism, Weak and Strong
  • Weak Paternalism overriding an incompetent or
    doubtfully competent patients wishes
  • Courts have accepted weak paternalist excuses
    when overriding the patients wishes is required
    to relieve the patients serious pain or
  • Weak paternalism is also mitigated if exercised
    to gain informed consent. Garrett calls such in
    the service of autonomy. Vaughn says as much p.52

Paternalism, Weak and Strong
  • Restraints restraints are justified on weak
    paternalistic grounds when patients are confused
    or disoriented, posing a danger to themselves.
    Their use should include safeguards
  • Periodic patient visits
  • Approval of supervisors and or physicians
  • Written justification

Paternalism, Weak and Strong
  • Garrett notes trepidation regarding paternalism
    on p 42
  • we insist that there is no general authorization
    for even weak paternalism. Each case needs to be
    studied, and exceptions should be made

Therapeutic Privilege
  • The law has recognized paternalism under the name
    Therapeutic Privilege.
  • Therapeutic Privilege the privilege of
    withholding information from the patient when the
    physician believes that the disclosure will have
    an adverse effect on the patients condition or

Therapeutic Privilege
  • 3 conditions guide the use of therapeutic
  • Its use must not be based on generalities, but on
    the actual circumstances of the particular
  • The physician must have a founded belief, based
    on intimate knowledge of the patient, that full
    disclosure will have a significant adverse effect
    on the patient
  • Reasonable discretion must be used in the manner
    and extent of the disclosure

Therapeutic Privilege
  • Garrett dislikes this legal device notes 2
    problems with it
  • Research fails to confirm full disclosure
    adversely effects patient condition or health
  • It is a denial of patient autonomy

Futile Treatment
  • Vaughn notes that sometimes physicians and
    patients disagree in reverse the patient wants
    treatment and the physician refuses.
  • Can happen over
  • amputation fetish
  • worthless or unproven drugs, but more often,
  • Sanctity of life v. Futility

Applying Major Theories
  • Look at pp 56, 57.
  • Utilitarians will be tempted to use Paternalism.
  • How can J.S. Mill think its okay to let someone
    ruin their life (supposing they choose to die or
    shorten their life by refusing treatment)?
  • How can Kantian physicians allow someone under
    their care to commit suicide by refusing
    treatment? Isnt suicide always wrong?

Applying Major Theories
  • On page 57, the book says Natural Law theory is
    more paternalistic than Kantian ethics, but
    doesnt say why.
  • Why should it be?
  • What is the doctrine of double effect?
  • Read the six examples under Applications here

Applying Major Theories
  • What would a Virtue Theorist think?
  • How would Aristotle go about deciding whether
    Paternalism is always or never justified?

  • Vaughn, L. (2010). Bioethics
  • Garrett, T. M., Baillie, H. W., Garrett, R. M.
    (2001). Health Care Ethics (4th Edition)

Cases for Evaluation
  • Case 1 Prayer, Medicine, and a Childs Death
  • Do you agree with the courts decision to reverse
    the manslaughter conviction?
  • Should parents have the right to refuse medical
    treatment for their children on religious
  • What moral principle would support your judgment?
  • See the rest on page 60, Vaughn.

Cases for Evaluation
  • Case 2 State Paternalism and a Pregnant Woman
  • Do you agree with the Supreme Courts decision?
    Why or why not?
  • Should the state force pregnant women to behave
    in certain ways while carrying a fetus?
  • Is a pregnant woman guilty of fetal abuse if
    she refuses to eat properly?
  • Drinks any amount of alcohol?
  • Forgoes prenatal care?

Cases for Evaluation
  • Case 3 Medical Futility
  • Do you agree with the hospitals decision to
    withdraw care?
  • Do you agree with the childs parents?
  • Do you accept the sanctity of life view, or think
    quality of life should determine what to do in
    cases like this?
  • How do you justify your view?