Paternalism

Abstract

Paternalism and especially medical paternalism, the paternalism of physicians and other healthcare professionals toward patients, occupied center stage in the early decades (1970s–1980s) of bioethics, especially in bioethics in the United States. The concepts of paternalism and medical paternalism in bioethics have roots in the general concept of paternalism, the assertion of epistemic and moral authority, and the power such authority justifies, over children by fathers, historically, and parents. Utilizing relevant ethical concepts and principles, the concept of medical paternalism is elucidated, to identify its individually necessary and jointly sufficient conditions: (1) a physician or other healthcare professional undertakes actions designed to limit the exercise of the patient’s autonomy (2) on the basis of clinical judgment and decision-making that are reliably beneficence based about how to protect the health-related interests of the patient from the consequences of the patient’s decisions and actions based on them. The presumption in bioethics, especially bioethics in the United States, that medical paternalism was an accepted ethical norm and therefore common clinical practice in the history of medicine is described and then called into question. This discussion suggests that the importance of medical paternalism for the future of bioethics has become an open question.