Paternalism: Are we overreacting?

I think that like all ethics movements, the medical ethics debate can at time take on an extremist stance. There's such a fear in stating medical opinions or best options (among healthcare professionals), that this fear ultimately ends up affecting medical care. I think that doctors should hopefully have the experience and knowledge to ascertain what is the best medical option/treatment for patients.

Dr. Gawande discusses how most "well" people say that they would like to dictate their healthcare decision, while only 12% of cancer patients say they wouldn't want to defer to the advice of their doctor. I think that doctors have a duty to provide explanations about all possible treatment options and to provide objective advice about medical therapies and risks; however, I do think that patients and families appreciate a certain degree of subjectivity and personal preference.

Dr. Gawande recounts his own experience when his youngest child was hospitalized for a respiratory infection and the doctors and him debated whether or not his daughter should be intubated. He emphasizes that he wanted the doctors to be the decision makers so he wasn't forced to feel the guilt of a (possibly) wrong decision. I think it's fair to say that even for non-doctors there is a certain comfort and deference in responsibility in having someone else decide the best healthcare option. As patients we assume that the specialist has more exposure to a various condition and treatment options and we acknowledge that the medical profession exists as a remedy to our own limited knowledge.

I understand the sentiment that patients have a right to know about their medical condition. However, I think it's ironic to note that many families ask doctors to withhold information about a prognosis or disease. But I think that allowing patient's to be "autonomous" decision makers who are embarking on a bad decision creates a whole new frustration for doctors. It goes against medical training and the professional teachings to withhold treatment or allow patients to choose a bad alternative. I think that medical ethicists ought to acknowledge that medical care cannot always be simply reduced to preserving patient autonomy. This becomes clear in Gawande's recount of a patient with pneumonia who was certain to die without ventilation but refused the treatment. Subsequently, when the patient passed out he was intubated. I think that these scenarios are not clear cut and doctors feel a professional obligation to do what they believe is in the "patient's best interest" in spite a patient's explicated desires. If a person presents themself to a doctor or medical institution for care, I think it is fair for doctors to act in a manner to provide them with the best possible outcomes- it seems to be a deference we should make to their training.