Paternalism in the Doctor-Patient Relationship

One of the biggest issues in the doctor-patient relationship is the worry about paternalism: are doctors too forceful in their patients’ treatments? What is the appropriate balance between doing what you think is best for a patient, and respecting that patient’s wishes if they don’t agree with your medical opinion?

Paternalism springs from the idea of the “father knows best” physician whose authority is unquestionable. I was moved by Gawande’s book because he reveals doctors as human beings. It is natural to think of a machine as unyielding, but it is hard to believe that is impossible to change a human’s mind. Doctors are under a lot of pressure to deliver, and when a patient’s wishes deviate from their idea of excellent medical treatment, they may feel as though the patient is actually trying to hinder their plans. In order to take on paternalism, we have to decide if the doctor’s obligation to provide the best medical care possible or to respect the patient’s wishes is more important. It’s possible to strike a balance, but the specter of paternalism will always loom so long as these two obligations are in conflict.

This is complicated by the rise of the consumer-patient, who is armed with online medical advice and bombarded by the seductions of DCTA. Many have argued that the age of information has allowed the patient to take greater control of his health and healthcare. However, others worry that this deluge makes patients more susceptible to quackery. It’s important to remember that this kind of changed relationship is only possible among those who have access to these online advice sites in the first place, and who have the confidence to interpret them, giving the doctor-patient relationship new sociopolitical implications. But a similar phenomenon has existed for much longer with regards to so-called “folk” remedies, which were taken not as a form of alternative medicine, but the medical truth. It is paternalism to reject a patient’s right to perform bizarre rituals, or to disallow a patient to pray in lieu of medical treatment, etc.?

As Kiminstry argues, just as it is paternalistic to deny a patient’s wishes, so too is it paternalistic to deny the right of a patient to yield authority. Many patients, especially those who don’t frequent WebMD, still defer to doctors, asking, “What would you do if it was you?” Just because a doctor doesn’t want to be perceived as paternalistic doesn’t mean he should take a hands-off approach and serve only as a distant provider of options—he should be allowed to infuse his medical opinion into that presentation, but realize that it is just that, an opinion.