Goldman - refutation of medical paternalism

MEDICAL PATERNALISM

Medical paternalism is when a doctor overshadows a patients’ ability to make decisions and/or decides to not relay correct information about their health for the sake of their harm. There are three things to notice about this topic:

  1. Medical paternalism is not different from paternalism as a whole; the same argument from Mill and Dworkin applies here. On the other hand, it's in one area where there are puzzling cases related to the superior knowledge that doctors acquire.

  2. Typically, medical paternalism is allowed only for the patience' sake, not for the third person’s

  3. Typically, medical paternalism is allowed only to avoid harm, not for any benefits

EMPIRICAL VERSUS MORAL ARGUMENT

Empirical: asks whether or not honoring the person's preference will in fact (based on experience) harm them

Moral: can medical paternalism be allowed despite the harm to patients?

STRUCTURE OF THE EMPIRICAL ARGUMENT

  1. If doing something causes harm to the patients in their care, then doctors are allowed to not do it

  2. Sometimes, supporting the patient's preference will harm them

  3. Therefore (in case #2), doctors are allowed to not support the preference(s) of the patient

RESPONSES TO THE EMPIRICAL ARGUMENT

Sissela Bok, “in general, it appears to be incorrect that patients do not really want bad news, cannot accept or understand it, or are harmed by it.” = Complete rejection of (#2)

Allen Buchanan, “questions the ability of the doctor to make a competent judgment on the probability of harm to the patient, a judgment that would require both psychiatric expertise and intimate knowledge of the patient himself.” = Does not agree with (#2), but also rejects a blanket empirical perspective that relates to all cases

NOTE! The differences in these arguments are very subtle

NOTICE [PER BUCHANAN'S VIEW]

  1. If the cause of the behavior results in harm to the patient in ways of doctors know, then doctors are allowed to not move forward with the act

  2. Sometimes, doctors are aware that supporting the preference of the patient will in fact harm them

  3. If that's the case (as in #2), doctors are allowed to not honor the desires of the patient

NOTE! Buchanan doesn't assume what the doctors can discern Angela some change the psychological impact of supporting or not supporting the patient’s preference

BUT WHAT IS HARM ANYWAY?

If it is recognized that circumstances have been shifted or lowered around the person’s certain level on their preference scale, it is harm. NOTE! This is not moralized. Two indications of harm:

  1. “Certain states of Affairs are such that the vast majority of us would wish to avoid them in almost all conceivable contexts: physical injury, hastened death or depression itself for example.”

  2. “The second source of a concept of harm independent of individual differences in subjective preferences is ideal-regarding: when the development of an individual capable of freely and creatively formulating and acting to realize central life projects is blocked, the person is harmed, whether or not he realizes it, and whether or not any of his present desires are frustrated.”

IMPORTANT! The main thing to focus on is the deviation from the preference

MORAL ARGUMENT (GOLDMAN'S RESPONSE)

  1. Certain information released to the patient will, at times, increase depression and physical deterioration, or end in a choice of medically nonoptimal treatment

  2. Certain information released, therefore, or sometimes likely to be harmful to the patient's health. It can even lead to death

  3. Good health and a long life can be assumed to be the common preference for patients who placed themselves under physicians’ care

  4. …

  5. Therefore, paternalism is justified: doctors can override patients’ reference and reveal information about risks.

VALUE OF SELF-DETERMINATION (GOLDMAN'S POSITIVE ARGUMENT)

A person's personal autonomy it's highly vital to their own life. It's so vital that no other amount of other goods, avoidance of personal evils and pleasures can triumph that. The majority of the population are not willing to give up the decisions that are important to the course of their lives to others even if it's for an exchange for a possibly, or proven, higher level of happiness or less risk of suffering.

REMEMBER! Mill’s argument has two parts:

  1. The value of autonomy: there is high value that is instantiated in people living an autonomous life.

  2. Epistemic argument: only people know what's best for them

A way to critique Goldman's argument come from circumstances where a partner that you choose for yourself has suboptimal characteristics or flaws that is detrimental to the relationship but a partner chosen by some sort of algorithm is slightly more compatible to you