DE LA SALLE HEALTH SCIENCES CAMPUS – COLLEGE OF MEDICINE

Detoxicol
SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: July 29, 2005
Topic: Paternalism Transcriber(s): Jaime Aherrera
Lecturer: Dr. Melchor Frias IV No. of pages: 2

PATERNALISM
• Involves acting without consent, or even overriding the Patient’s Wishes, wants, or actions in order to benefit the
patient or at least prevent harm to the patient
• Respect for Autonomy and Desire to Help others
• Doing Good without the Patient’s Consent
• From the act of being a “Father” – control over patient

I. TWO ELEMENTS OF PATERNALISM

• The absence of Consent or of the Overriding Consent
• The beneficent motive (welfare of the patient) – something good will come out with the Intervention

**IT IS NOT PATERNALISM:

1. When the Health Care provider acts to prevent the patient from causing serious injury to others
 This is specified by LAW
 Ex) Psychiatric Patients may hurt others – to prevent this, doctor give patient sedatives without
consent to avoid injury to others

2. If the Health Care Provider overrules the Patient for the Convenience or Profit of the Provider
 Provider = Medical Personnel
 Do Intervention before certain effects would be expected
 Ex) Nurses carry out doctors order in hurry (IV administration) – the patient may be hurt

3. If the health care professional refuses to go along with the Patient’s wishes because these wishes are
against the conscience or professional standards of the provider and vice versa
 Ex) it is the right of the MD to refuse treatment especially with regards to Ethical Matters such as
Abortion, Tubal Ligation, etc

II. TWO TYPES OF PATERNALISM

 there is No general authorization for both strong and weak paternalism
 Weak Paternalism is on a Case-to-Case Basis

A. Strong Paternalism (Extended Paternalism)

o attempts to override the wishes of a competent person
o always UNETHICAL

**Strong Paternalism is Ethically Rejected

 It is wrong to override consent when patient is competent
 The competence of an individual to make decisions for another competent individual would require
both knowledge of the other person’s values and all the factors influencing their lives
 Health Care professionals DON’T have the right to enforce value judgements on the Patient on the
grounds that “Doctors Know Best!”
 It would be rare for the health professionals who knew all the factors influencing the life of the
patient

B. Weak Paternalism (Limited / Restricted Paternalism)

o consent is missing or the health care provider overrules the wishes of an incompetent or a
doubtfully competent patient
o Weak Paternalism is sometimes called Cooperative Paternalism when one of its purposes is to
restore the patient’s competence so that the patient may give Informed Consent – can be ethically
accepted
o we are dealing with an Incompetent Person
 o ex) when patient is in danger of harming himself – physician should give medications to calm the
patient

**Four Conditions for an Involuntary Confinement (Psychiatric Patients)

 Can be Treatable
 Mental Illness is Obvious
 Evidence of Mental Deterioration
 Person must be suffering from Mental Illness

III. JUSTIFICATION OF PATERNALISM

• If the Harms Prevented from occurring or the benefits provided to the patient outweighs the loss of independence
and the sense of invasion caused by the interference (Benefits > Harm)
• If patient’s condition seriously limits his/her ability to choose autonomously (ex. Psychiatric Patients)
• If the interference is universally justified under relevantly similar circumstances

IV. RULE OF THUMB INVOLVING PATERNALISM

• Decisions about Health, Life, and Death are NOT Merely Medical Decisions, but involve the Good of the Society
and the Good of 3rd Parties (relatives, staff) as well as the Values of the Patient

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SDLS 2008
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