An Exploration of Medical Ethics: Paternalism vs. Self-Determination

This essay delves into the multifaceted realm of medical ethics, specifically examining the moral arguments surrounding paternalism and the rise of self-determination in healthcare. It begins by defining paternalism and its historical significance, highlighting the traditional doctor-patient relationship rooted in the Hippocratic Oath. The essay then presents the moral arguments in favor of paternalism, emphasizing the doctor's expertise in promoting patient health. However, it critically assesses these arguments, referencing Alan Goldman's objections to medical paternalism, particularly concerning the infringement on patient autonomy and the withholding of information. The essay then transitions to the concept of self-determination, tracing its emergence as an alternative model emphasizing informed consent and patient participation in medical decisions. It explores the legal implications of denying self-determination and concludes by arguing that self-determination is a convincing perspective, allowing patients to make choices based on their values and understanding of a good life, while also acknowledging the limitations of self-determination in patients with severe mental disorders. The essay provides valuable insights into the evolving landscape of medical ethics and the balance between medical expertise and patient autonomy.

Running head: MEDICAL ETHICS 1
Medical Ethics
Name
Institution
Date

MEDICAL ETHICS 2
Introduction
The essay intends to answer a number of questions. The first objective is to determine the moral
argument in favor. The second argument is to determine whether such moral argument is
convincing by referring to Alan Goldman’s objection. Lastly, the essay will explore the
argument for self-determination and determine whether they are convincing.
Patient autonomy is an essential, yet challenging, aspect within the context of
professional medical ethics. The current literature continually advocates for human freedom on
matters related to decision making on their livelihoods and more emphasis have been meted on
medical issues. Paternalism is the act of denying a person the right or autonomy with a purpose
of enhancing the common good of that individual or precluding harm on that particular person
(Husted, 2014). Paternalism is a classic type of relationship between a doctor and a patient who
has enjoyed absolute recognition in professional medical ethics for more than 20 centuries. What
is its essence? It was fixed in the root of the concept - the word "pater" (lat. - father). A doctor,
like a father who cares for his child, sympathizes with the patient, helps him, takes responsibility
for decisions made about his treatment. The paternalistic attitude is also present in the
Hippocratic Oath - in the position on managing the treatment process, the mode of which is
determined in accordance with the doctor’s powers and understanding in the interests and for the
benefit of the patient. In the realm of medical ethics, there are moral arguments that favor
paternalism. The central premise is the ideology revolving around the common knowledge that
doctors in their capacities are solely bestowed with critical skills and an understanding of the
need to advance longevity and health in various medical fields (Lamont, Jeon & Chiarella,
2013). Patients seeking medication do so to improve their health status, thus, according to
foundational ethics, patients have no obligation to go against these ethics based on the severity
and the irreversible harm that such moves might cause. With this focus, physicians within their
professional jurisdiction have ethical standards and guidelines which mandate them to override

MEDICAL ETHICS 3
patients’ rights with the aim of protecting these patients’ long-term desires (Lamont, Jeon &
Chiarella, 2013). However, this is not convincing as Alan Goldman highlights it. The author
expounds on the defects of medical paternalism which offers the insight concerning how the
patients’ rights of autonomy get intruded upon by the physicians who have to lie by withholding
medical information (Goldman, 1980). In this scenario, the right to decide what medical
treatment to withdraw or accept, and the right to informed consent is tampered with by the
practitioners.
Self-determination is a concept likely to replace paternalism. By the end of 20th century,
anti-paternalistic sentiments began to gain strength in society. Judgments about the collapse of
paternalism began to appear more and more often. Instead, the latter began to develop and
introduce new models of the relationship between the doctor and the patient, such as deliberative,
informational, technical, contractual, etc (Devettere, 2010). The development of these models
was actively pursued in the United States and Western European countries. What is the essence,
for example, of a scientific or technical model? From the point of view of its supporters,
medicine today is a science, and the doctor is a research scientist. But if a doctor is a research
scientist, he should rely only on objective facts and be impartial, i.e. free from any moral values
(Cserne, 2012). And if, for example, fetal therapy or regenerative (regenerative) technologies
using stem embryonic cells reach a level of statistical efficiency, their use should not be limited
by any value barriers either in the individual doctor’s consciousness or in the public
consciousness. From the point of view of Western researchers, nowadays, classical paternalism
gives way to the modern model of doctor-patient relationship - informed consent and self-
determination. Self-determination in medical practice has its backdrop on individual
participation in making decisions regarding their medical treatment (Pelto-Piri, Engström &
Engström, 2013). Failure to accord this right is an actionable tort subjecting doctors to liability
for trespass and battery entrenched in common law. The perspective is convincing as it allows

MEDICAL ETHICS 4
patients to live according to the conception of a better life bound by justice; thus, everyone takes
accountability over their lives regardless of the circumstances that may abound during
medication. However, it should be noted that patients with less severe mental disorders is quite
capable of self-determination, the expression of their own interests, the distinction between
benefit and harm.

MEDICAL ETHICS 5

MEDICAL ETHICS 6
References
Cserne, P. (2012). Freedom of contract and paternalism: Prospects and limits of an economic
approach. New York, NY: Palgrave Macmillan.
Devettere, R. J. (2010). Practical decision making in health care ethics: Cases and concepts.
Washington, D.C: Georgetown University Press.
Goldman, A. (1980). The refutation of medical paternalism. The moral foundations of
professional ethics.
Husted, J. (2014). Autonomy and a right not to know. The right to know and the right not to
know: genetic privacy and responsibility, 24-37.
Lamont, S., Jeon, Y. H., & Chiarella, M. (2013). Health-care professionals' knowledge, attitudes,
and behaviors relating to patient capacity to consent to treatment: An integrative review.
Nursing Ethics, 20(6), 684-707.
Pelto-Piri, V., Engström, K., & Engström, I. (2013). Paternalism, autonomy, and reciprocity:
ethical perspectives in encounters with patients in psychiatric in-patient care. BMC
medical ethics, 14(1), 49.