Healthcare Ethics

Abstract

This chapter discusses the concepts of medical paternalism and patient autonomy and their implications for the doctor patient relationship, medical practice, and healthcare. For more than 25 centuries, paternalism was the dominant model of the doctor-patient relationship, where the doctor uses his skills and knowledge to serve the best interests of the patient as a moral obligation. This is in compliance with the classical ethical principles of the Hippocratic Oath: beneficence, nonmaleficence, truth-telling, confidentiality, and fidelity to the patient. The paternalistic approach assumes that patients and doctors have the same goals, that physicians can accurately judge patient preferences, and that only the physician had the expertise necessary to determine what should be done. All theories of autonomy agree on two essential conditions: the first is liberty, specifying the independence from controlling influences; and the second is agency, referring to the capacity for intentional action. Used in clinical ethics, autonomy functions primarily to examine decision-making in healthcare and serves to identify actions that are protected by the rules of informed consent, informed refusal, truth telling, and confidentiality. An important difference between autonomy and paternalism is the weight given to patient values. Autonomy considers patient values as decisive. Modern paternalism considers these values as only one factor among others weighed by the physician in making a decision. Moral values are culturally relative. Autonomy must be balanced with other morally important concepts in the doctor-patient relationship, including loyalty, integrity, solidarity, and compassion.