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The Principle of Beneficence vs Patient Autonomy and Rights

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The Principle of Beneficence vs Patient Autonomy and Rights

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Special Feature – Medical Ethics Essay

Singapore Med J 2002 Vol 43(3) : 148-151

Deconstructing Paternalism – What Serves the Patient Best? N H S S Tan (This Essay won the Singapore Medical Association Ethics Essay Award (Non-medical Undergraduate Category) in 2001.)

ABSTRACT On the motion that “medical paternalism serves the patient best”, this essay reviews current arguments on medical paternalism vs. patient autonomy. Citing medico-ethical texts and journals and selected real-life applications like electroconvulsive therapy (ECT) and the advanced medical directive (AMD), the essay argues that medical paternalism cannot serve the patient best insofar as current debates limit themselves to “who” wields the decision-making power. Such debates side-step “what” the patient’s best interests are. The essay further argues through the case of Traditional Chinese Medicine (TCM), and acupuncture in particular, that the current dominant Western school of thought excludes other forms of “alternative” treatment through medical paternalism. Singapore Med J 2002 Vol 43(3):148-151

N H S S Tan Second-year mass communication student at Ngee Ann Polytechnic Correspondence to: Noel Hidalgo Tan Suwi Siang Email: noelbynature@ pacific.net.sg

Although probably not written by Hippocrates (c. 460 – c. 477 BC) himself, the Hippocratic Oath is one of the oldest, most binding code of conduct today. The oath expresses the aspirations of the physician, and sets the ethical precedent by spelling out the physician’s responsibilities to the patient and the medical profession. Today, the Hippocratic Oath has been adopted and adapted world-wide; all physicians take the oath in some form or another. In Singapore, the doctor who undertakes the Singapore Medical Council’s Physician’s Pledge promises to “make the health of my patient my first consideration” and “maintain due respect for human life” (pars. 4, 9). The primary concept behind the oath is the principle of beneficence, which...