Medical Ethics: Autonomy vs Paternalism

Paternalistic Decision Making

• Justified in emergency situations when patient lacks capacity and there is no time to consult relatives
• Exception to the general principle of autonomy

Autonomy vs. Paternalism

• Patients presumed to have sufficient capacity to decide on their own medical treatment, unless evidence suggests otherwise
• Forces that limit or obstruct patient autonomy: compromised competence, stress of illness (e.g. patients with stroke, coma, or dementia)
• Balance between autonomy and paternalism needed to provide the best help to the patient

Honesty and Truth Telling

• APhA Code of Ethics for Pharmacists (1994): pharmacists have a duty to tell the truth
• Patients have the right to truthful communication regarding their medical condition, treatment, and alternative treatments
• Challenge: balancing honesty with potential harm from full disclosure of every detail

Autonomy

• Establishes a patient's rights to self-determination and moral right to choose their own life plan and action
• Patients need to be informed in language they understand, with unbiased explanations of treatment options, risks, and benefits

Paternalism

• Health professionals seeing themselves in a parental role, knowing what is best for the patient
• Fails to consider patient preferences, beliefs, and practices

Informed Consent

• Critical element of any theory that gives weight to autonomy
• Requires a dialogue between patient and provider, including:
  • Diagnosis or nature of the condition
  • Purpose and nature of the treatment
  • Potential complications and risks
  • All reasonable alternative treatments and their relative risks and benefits
  • Option of taking no action