Paternalism as less than Evil

In his article, McKinstry categorizes the doctor-patient relationship into four classes: the autocratic doctor, the paternalistic doctor, doctor as agent, and patient yielding autonomy. Reading through these descriptions, I couldn’t help considering these as rather absurd and highly theoretical lines with little practical applications. As Dr. Pacheco, the family physician who came to speak last week, suggested, many patients actually come to her needing some level of hand-holding. Although we might feel it unfair, as physicians, we’re bound to frequently be asked questions like, “What would you do if it were you or your beloved one?” Especially in a society like modern America, the patients are asking their doctors for a genuine personal opinion, with the fundamental understanding that their ultimate choices are their own.

Therefore, I wonder if “paternalistic” medicine is necessarily something to be bashed. Years ago, in settings where widely accepted customs deified doctors to the levels of figures whose opinions had to be upheld, paternalistic medicine might have been manipulative, even abusive. However, today, “paternalistic medicine” to me sounds a lot less cold and more personal, even more intimate.

McKinstry’s categories of the doctor-patient relationship must all be mixed and balanced. To say that the figures of the autocratic and paternalistic doctor must completely be demolished, however, would be ignore a pragmatic need by today’s human patients.