Paternalism in the Medical Profession
Philosophy 235 EC: Biomedical Ethics
“The only appropriate and realistic model of the Dr.‐patient relationship is paternalism. Doctors are the medical experts; most patients have little, if any, reliable medical knowledge; implicit trust in one’s physician is essential to the healing process; and doctors have the responsibility for our health and therefore have the duty to make all the important medical decisions.” Critically assess that claim.
The issue of doctor patient relationships has become more and more prevalent in our world today. It is hard to draw a clear line in deciding what the appropriate roles are of both the patient and the medical professional. The claim that the paternalistic model is the appropriate and most realistic model will be argued in this paper. This model states that the doctor is the one in complete control, making all decisions on behalf of the patient, and the patient grants the doctor this responsibility, obeying any orders. In this model, patients act as children, who are ignorant and unknowledgeable, and doctors act as parents, not only guiding the child in the right direction, but also, actually telling them what to do. Should doctors really hold complete responsibility for our health? Should they be the ones to make all the important medical decisions without patients having any say? This model will be argued in this paper in order to critically assess whether it should be dominant in our present society.
“The traditional view held by physicians themselves was that the physician is the captain of the ship, and that the patient has to follow orders.” This view has only been strongly believed since the 19th and 20th century, when medical professionals were granted almost complete control over all decision making by their patients. Before that time, going to see a doctor was perceived as a last resort, and many would ignore their doctor’s advice altogether. Over time, this view has shifted and society began to believe that physicians “knew best, and therefore had not only the right but also the duty to make the decision.” Today, less and less citizens are continuing to agree with this point of view, and instead other doctor patient relationship models have emerged and been identified by Robert Veatch: the engineering model, the priestly model, the collegial, and the contractual model.
The three alternative models to the priestly (paternalistic) model have emerged from a more contemporary perspective. The engineering model states that the relationship between the two parties would be nothing more than the doctor simply presenting the patient with the diagnosis, prognosis, and treatment options. Any decision as to which route to take is left entirely up to the patient. As the textbook explains, the doctor is nothing more than an “applied scientist”, or a “plumber without any moral integrity”, since ethics and values do not come into play in this relationship. Although I do not entirely agree with this model, the responsibility is lifted off of the physician, and the patient is given freedom to decide. This would follow the argument of self-determination, as said by Dr. Ornstein. This is the belief that all people who are competent should be the ones in control of determining their own fate. Society has not always believed or relied on medical professionals. In fact “until well into the nineteenth century, the physician was seen as a figure of last resort.” They were deemed useless and even harmful. With this in mind, I wonder why in our day and age, we would rely even more on physicians than we did in the past? Today, we have the privilege of finding out almost anything we need to know within minutes via the Internet, and that is why sometimes, it is the patient that knows more than his own doctor. It is important that patients assume some level of responsibility for their own health, instead of relying on doctors, and the engineering...
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