PATERNALISTIC HEALTHCARE MODEL

An Explanation of Why the Formerly Supreme Paternalistic Model of Health Care Is Now Inferior To the Principle of Autonomy



An Explanation of Why the Formerly Supreme Paternalistic Model of Health Care Is Now Inferior To the Principle of Autonomy

Introduction

Paternalism is described as a dominant attitude of one over another." It can be defined as authority exercised in a way that limits individual responsibility? It has also been stated as being unilateral decision-making that does not accord with a client's expressed wishes or value system. to Paternalism was widely practiced years ago because health care practitioners were usually expected to make the best decision for the patient. Gillon.'! (Davis, 2000) suggests that sometimes a doctor has to be paternalistic to patients, i.e. do things against patient's immediate wishes or without consulting them, to do what is in their best interests. Further, that medical ethics since Hippocratic times has required doctors to do the best for their patients (Davis, 2000).

Thus, paternalistic medicine is where health carers do for patients what they think is best for the patient, because they are the experts with the expert knowledge. They have seen many patients usually with the same problems, and therefore know how to deal with them. The patient does not. There is often little communication with the patient let alone discussion of options. Patients often feel unable to ask questions and therefore lack control, power and self-determination. In other words, lack of autonomy. From the health carer's perspective, paternalistic practice is less time consuming, which is an important factor in a busy health care unit or clinic. Further, it enables emotional distancing for practitioners, which maybe for some is the only way they can cope with the situation before them. Fortunately, the practice is diminishing. The trend legally and morally is to include the patient in the decision-making process. However, the risks of paternalism continue to be a much-debated issue in health care (Davis, 2000).

For instance, the idea of 'rational non-interventional paternalism' has arisen. This is a practice in which health carers form conceptions of what is best for their patient, and argue rationally with them. Madder!' argues against rational non-interventional paternalism, because it undermines the importance of patient choice and so threatens autonomy. A concept of mutuality has also been put forward!" that principally focuses on interactions between providers and clients/patients. It has been shown to balance power and respect, promoting productive provider-client communication and fostering positive and lasting health care outcomes." It may be that this approach is the way forward in this complex issue, because a mutual health carer-patient relationship balances respect and beneficent guidance based on practitioner's clinical expertise (Davis, 2000). It protects the moral integrity of both patient and practitioner. It could be that the debate concerning autonomy and paternalism will continue for a long time yet, because a true comparison can never really be made between them. Essentially autonomy and paternalism are different qualities in as much as autonomy is the embodiment of a ...