Paternalism as a field of bioethical concern

Authors

  • Maja Žitinski

Keywords:

paternalism, power, right, beneficence model, autonomy model, moral reason, informed consent

Abstract

Paternalism becomes an issue in difficult situations when a physician in some way intentionally

affects and limits the decision-making autonomy of the patient. Even though paternalism

is literally interpreted as an attitude that appreciates paternal warmth, treating someone who

is not a child paternalistically means treating him wrongly. It is reasonable for people to regard

the respect of their rights as a protection against subjugation. If doing wrong to another person

is contrary to what I would do to myself, then I must admit that nonreversible behaviour

is wrong in itself. Whoever engages in nonreversible behaviour is doing wrong, or performing

an irrational act. Autonomy and rights belong to the key metaethical concepts because vulnerability

of all rational beings to subjugation is universal and our rational capacity to recognize

it establishes its primacy over other moral ideals. Vulnerability to subjugation is an intrinsic

qualification of human existence because every human being can harm the other. My duty

to be accountable for your vulnerability is implied in my power to harm you. In order not to

harm each other I must move from the logic of power, to the logic of duty. What makes selfish

action unethical is not that the agent has been a self centred paternalist only, yet the fact

that selfish interests have served as criteria for action. This paper aims to infer what sorts of

virtues are required to direct the physician to meet the interests of the patient as if they were

his own, just for the sake of moral reason which requires not to harm the other person. The

patient’s right to accept or refuse medical care changes the position of the physician’s power

over the patient because moral principles are those of reciprocity. Bioethical quest for a correct

method all moral agents ought to be guided by refers to the conviction that it is rational to

come as close as possible to the ideal moral judgment. Since a system of moral rules free of

conflicts between principles and exceptions to principles does not exist, physicians are constantly

confronted by conflicting demands in their need to decide what kind of consideration

is weightier. Since paternalism is against the informed consent, it insists that patients believe

in the doctor’s conscience and skill and act as the doctor tells them to do. If the physician acts beneficently to protect the patient from harm and the patient resists, the physician acts from

the perspective of medicine which violates the autonomy model. Bioethics aims to advance

human good because it provides a connection between goals of normative ethics and the

establishment of principles for handling violations of rationally grounded moral decisions.

 

Published

2012-04-15