Exam 1 - Paternalism

What is medical paternalism? 

Restricting or overriding patients’ autonomy for their own good

What is the distinction between weak medical paternalism and strong medical paternalism?

• weak medical paternalism: A health care professional restricting or overriding a patient’s autonomy for the patient’s own good when there’s reason to believe the patient’s autonomy is significantly diminished. 

• strong medical paternalism: A health care professional restricting or overriding a patient’s autonomy for the patient’s own good when there’s NO reason to believe the patient’s autonomy is significantly diminished.

What, according to Goldman, do proponents of medical paternalism presume patients value more than anything else? 

Health and prolonged life can be assumed to have priority among preferences for patients who place themselves under physicians’ care. 

Goldman gives two arguments pertaining to the social policy level which allegedly show that medical paternalists should not presume what they do about a patient’s rational ordering of values. In a PowerPoint presentation, I put these two arguments in the form of modus tollens (or denying the consequent): 

i. If p, then q. 

ii. Not q. 

iii. Therefore, not p. 

What is one of these two arguments? 

[structured as a modus tollens to refute the paternalistic assumption about a patient's values] 

i. “If our primary goal were always to minimize risk to health and life, we should spend our entire federal budget in health-related areas,” such as highway safety and hospitals. 

ii. The idea that we should spend our entire federal budget in health-related areas is “ludicrous.” 

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iii. Therefore, our primary goal is not always to minimize risk to health and life. 

Goldman goes further than faulting medical paternalists for presuming what is at the top of a patient’s ordering of values; he makes a case for the freedom to make important decisions about one’s life (i.e., self-determination or autonomy) as being at the top of that list. What is one example he gives in support of the view that people in general (and hence patients in particular) place autonomy at the top of their ordering of values?

 importance of choosing: 

• whom we marry 

• our career 

• a college to attend (or choosing NOT to) 

At the end of his essay, Goldman gives a second argument in support of the “super-value” of autonomy that, unlike his first argument, is independent of what people as a matter of fact value. (In the parlance of moral philosophy, such independence makes the argument “ideal-regarding” or “perfectionist.”) What is this second argument in support of the super-value of autonomy?

i. “What has value does so because it is valued by rational and autonomous person.” 

ii.“Autonomy itself is necessary to the development of such valuing individual persons or agents.” 

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iii. “[Autonomy] is therefore not to be sacrificed to other derivative values. To do 

so as a rule is to destroy the ground for the latter.” 

If health care professionals view autonomy as a threshold concept only, then what, on Terrence Ackerman’s view, is respect for patient autonomy likely—and inadequately—going to amount to?

- backing off—don’t interfere with patients’ decision-making. 

- if patients are sufficiently autonomous, they’re autonomous, period. Consequently, they have the right to make treatment decisions. 

If, on the other hand, health care professionals come to appreciate that autonomy is a matter-of-degree phenomenon, then what, on Ackerman’s view, is respect for patient autonomy likely—and more adequately—going to involve? 

- respect for autonomy isn’t a mere limit to what health care professionals may do. Rather, respecting autonomy is a goal for health care professionals to strive for: restoring full autonomy. 

Ackerman views the physician with a seriously ill patient as a kind of detective with a particular end in mind. What, on Ackerman’s view, should such a physician, as detective, try to uncover and deal with? 

- True respect for autonomy requires acting to help these patients restore full control over their lives. And restoring full autonomy may require acting paternalistically in one way or another. 

Does Ackerman support medical paternalism? If so, why? If not, why not? 

- Yes, Terrence Ackerman supports a "soft" form of medical paternalism [link]. 

- He argues that illness introduces severe psychological, cognitive, and physical constraints that naturally compromise a patient's true capacity for self-determination. Therefore, simply practicing noninterference abandons the patient; doctors must actively intervene and override a patient's immediate, compromised choices in the short term to neutralize those constraints and ultimately restore the patient's long-term autonomy.