Paternalism in Medicine
Paternalism has become a politically unpopular word because of its association with physicians telling patients what is good for them, without regard to the patient’s own needs and interests. This limited sense of paternalism is improper and has been obviated by informed consent requirements. In the larger sense, however, the relationship between medical care practitioners and patients is a paternalistic, beneficent relationship: the medical care practitioners are expected to do what is medically best for the patient. While that might even include assisted suicide in an extreme case, it never includes improper medical care given only because the patient requests it. Despite the importance of patient involvement and informed consent, medical care practitioners are expected to do what is best for their patients. In certain public health situations, they are also expected to consider what is best for society, even if that may not be in the best interests of the patient.
The courts’ skepticism in cases in which patients allegedly make an informed choice of medically improper treatment highlights the expectation that physicians will offer patients only the choice of medically proper and indicated treatments. This reflects a general societal consensus on what constitutes acceptable medical care. In most cases, physicians, patients, and society agree on the desired outcome and the appropriate spectrum of treatments to accomplish that outcome. While this is not meant to minimize the very real conflicts between physicians and patients, debates over contentious issues such as abortion, right to die, and entrepreneurial medical practice tend to obscure the congruence of interests that define the vast majority of patient care.