Paternalism Versus Autonomy

In the medical field there emerges a conflict that all physicians will eventually come to deal with, or are already dealing with regularly; that is the conflict of Autonomy and informed consent versus Paternalism and the doctor's intervention. In one hand, Autonomy is the principle of non-interference and the right to self-governance; informed consent is the concept that "Every human being of adult years and sound mind has a right to determine what shall be done with his own bodyÐ'...(102)" it is the exercise of a choice after being informed of the process and risks of a medical treatment. While in the other hand lies Paternalism; "the interference with, limitation of, or usurpation of individual autonomy justified by reasons referring exclusively to the welfare or needs of the person" being overridden (61). In other words: doctor knows best, doctor chooses best, doctor does best- all for the welfare of the doctors patient.

Taking a closer look at Autonomy we see that there are some obstacles that might become involved. First, by definition, it must involve a human of "adult years," and a "sound mind." This brings in some constraints that need to be addressed, other then the obvious age constraint. Terrence Ackerman in his report dated 1982 called "Why Doctors should intervene" gives light to various kinds of constraints. These include: Physical constraints; such as prison or bodily prevention, Cognitive constraints; someone with the inability to understand the information given to them, Psychological constraints; this would involve someone who is depressed or suffers from something like Alzheimer's disease, and Social constraints; a peer pressure or the cultural background of a patient playing a role in autonomous decisions. Considering the previous constraints from Ackerman's report, the answer is paternalism. When a patient has one or more of these constraints, the best way to make a decision concerning the welfare and needs of a patient is to allow the doctor to intervene, but this intervention must only be "justified by reasons referring exclusively to the welfare or needs of the patient" (61). The transparency standard is a standard that promotes patient autonomy it "requires the physician to engage in the typical patient management thought process, only to do it out loud in a language understandable to the patient" (115). In other words, the doctor must completely inform the patient, to the best of his ability, about everything; risks, procedures, situations, and allows patient to ask questions about any and/or all of these. But this standard still has the constraints that were listed earlier, you can "inform" a patient as much as possible, but if they aren't competent enough to comprehend the information or are being pressured into making decisions, then the questions must be asked: is it truly an autonomous decision? And is it even possible to not be "constrained?" In the end, some form of paternalistic action, with a respect to autonomy of the patient (who fits the criteria of a competent and non-constrained person), seems to be the best choice. In most cases, given the fact that the doctor informs his patient, the doctor usually knows best.

Even when the doctor knows the best, it doesn't always mean he should act