PATERNALISM

⤷ Comes from the Latin word “pater” which means “father” or paternus which means “fatherly”.
⤷ The act of being fatherly to someone as if were one’s own offspring.
⤷ Acting like a father to a person for his own good and interest
⤷ it is the policy or practice on the part of people in positions of authority of restricting the freedom
and responsibilities of those subordinate to them in the subordinates' supposed best interest.
⤷ It is the interference of a state or an individual with another person, against their will, and defended
or motivated by a claim that the person interfered with will be better off or protected from harm
(Encyclopedia of Philosophy, 2015)

Paternalistic Acts
⤷ An act that intends to protect or advance the interest of its recipient, although such an act may go
against the recipient’s own immediate desires or may limit his freedom of choice.

Several Types of Paternalism

• With Regards to Recipient Welfare
1. PURE Paternalism
⤷ Justifies intervention into a person’s life for the sole welfare of that person.
Ex: A child is told by his parents to eat vegetables because it is good for health.

2. IMPURE PATERNALISM
⤷ Justifies interference with another person not only for that person’s welfare but also for the
welfare of another.
⤷ A parent who need to have blood transfusion not only for his own good but also for the good
of his children.

• With regards to recipient’s defect and safety

1. RESTRICTED PATERNALISM
⤷ Supports intervention which overrides an individual’s action because of some defect or
weakness in that individual.
Ex: One may prohibit from doing something because of psychological incompetence.

2. EXTENDED PATERNALISM
⤷ An individual is restrained from doing something because it’s too risky.

• With Regards to Promotion of Good and Prevention of Harm

1. POSITIVE
⤷ One is forced into a rehabilitation program to promote his/her own good.

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 2. NEGATIVE
⤷ Vices are taken away from an individual to prevent that individual from any harm/violence

• With Regards to the Patient’s Sense of Values

1. SOFT PATERNALISM
⤷ The patient’s values are used to justify the intervention with his possible action or decision
Ex: A comatose patient is usually detached from life support machines because he earlier signified such
preference if ever he would be put in such situation.

2. HARD PATERNALISM
⤷ The patient’s values are NOT the ones used to justify a paternalistic act
Ex: Someone who supposedly knows what is good for a patient directs the latter with regard to what is to
be done or direct someone else to do this for the patient.

• With Regards to the Recipient of the Benefit

1. DIRECT PATERNALISM
⤷ The individual who should receive the supposed benefit is the one whose values are
overridden or disregarded for his own good.
Ex: The motorcyclist is forced by law to wear helmet is the one who will benefit in case of an accident.

2. INDIRECT PATERNALISM
⤷ An individual will be benefited, if one person is restrained from doing something
⤷ A child was abused in which the parents are restrained by law to protect the child.

IN THE MEDICAL CONTEXT

PERSONAL PATERNALISM
⤷ Is one in which an individual decides on the basis of one’s best knowledge of what is good for
another person

STATE PATERNALISM
⤷ Refers to the control exerted by the legislature, agency or other government bodies over
particular kinds of practices and procedures in medicine.

Justification of Personal Paternalism

o The recipient of the paternalistic act is sick and consults the physician seeking medical assistance
and expertise
o The recipient of the paternalistic act has some incapacity which prevents him/her from decision
making
o The probable benefit of paternal intervention outweighs the probable risk of harm from
noninterference
o The physician has an obligation to act in the best interest of the patient

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 o The patient upon consulting the physician voluntarily transfer his/her autonomy to the latter
based on the faith in the physician.

Justifications for State Paternalism

o Improve the good quality of medical education
o To upgrade a high standard of medical care
o To control drug addiction

APPLICATION OF ETHICAL THEORIES

Natural Law Ethics
⤷ Endorses both kinds of paternalism in medical context
⤷ If the patient doesn’t know what is good or bad for himself, the physician is in better position to
perceive what action or decision to be made in the best interest of the patient.

KANT
⤷ he perceive a person as a rational and autonomous agent and he is against Paternalism
⤷ A paternalistic act maybe taken as an interference with an individual’s autonomy and self
regulating will.

RAWL’s Theory
⤷ Morality is compatible with State Paternalism because society has the capability to decide to
institute a set of medical practices and policies that would promote common interests and
general welfare.

W.D.ROSS
⤷ Each person has a moral right to be treated as an autonomous agent who has to make decisions
for one self. However certain circumstances in which intervention or interference with an
individual’s autonomy would be legitimate.
Ex: A person who might be mentally incompetent to make decision would need paternalistic assistance.

UTILITARIANISM
⤷ Endorses paternalism insofar as state laws and policies are justified by the principle of utility.

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Principle of Beneficence
⤷ As this principle promotes “to do good and produce good” paternalism is endorsed if and only if it
is for the good or the better.

Principle of Non- maleficence

⤷ As this principle promotes “ do no harm” paternalism is acceptable if and only if harm or pain
should not be inflicted upon others regardless status.

Principle of Autonomy
⤷ Do not endorse paternalism because it entails the “right to self- determination”.
⤷ Believes that an individual is autonomous; hence he has the right to act and decide by and for
himself.

Principle of Justice
⤷ Paternalism is endorsed if and only if the patient is conscious.

Principle of Double- effect

⤷ Endorses paternalism if an act as long as it balance the good effect and the bad effect

Principle of Epikia
⤷ endorses paternalism as it opposed to the principle of autonomy.

Principle of Inviolability of Life

⤷ Do not accept paternalism as if another person decides for the other person does not respect the
life of the person.

Principle of Stewardship
⤷ Endorses paternalism as it is the principle which expresses the responsibility to take care of,
nurture, and cultivate what has been entrusted to him.

Principle of Fidelity
⤷ Endorses paternalism in medical context as this principle entails keeping the promises of health
care personnel to keep the patients from harm.

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VERACITY- truth telling
TRUTH TELLING
⤷ the right of patients or their families to receive information about their diagnosis and illness.
⤷ Truthfulness is summed in two commands
⤷ First, Do not lie, second, communicate with the person who has the right to know the truth
⤷ Every competent person has the right to information about himself or herself, and about what is
planned for him or her.
⤷ All the information must be disclose
⤷ The right of every individual to have insight into the situation (Baille,H, et al., 2013)

APPROACHES OF TRUTH TELLING

1. PERSON CENTERED
⤷ Gives importance to the patient as a person
⤷ Considers the patient as a person with a problem but not as a problem itself
⤷ The patient has the right to know the nature of one’s disease and the physician is morally
obligated to respect that right.

2. PROBLEM ORIENTED APPROACH

⤷ Considers the patient’s problem, illness or condition.
⤷ The doctor may not tell the truth for the best interest of the patient.
⤷ This approach is appealed to those who endorse the legitimacy of the use of placebos

Justifications of TRUTH TELLING

⤷ The moral quality of a person is taken away from them if someone denied whatever knowledge is
available about their condition as a patient
⤷ As patient, we have entrusted the physician any knowledge he has about ourselves, so the
findings are ours not his; hence, to deny them to us is to steal from us.
⤷ To deny a patient pertinent knowledge about himself in situation of life and death is a form of
deprivation on time to prepare for his own death and to carry out responsibilities based from his
actions and decision.

VERACITY IN HEALTH CARE SETTING

⤷ Refers to comprehensive, accurate and objective transmission of information as the way the
professional fosters the patients or subjects understanding

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VERACITY IS NECESSARY FOR 3 REASONS
⤷ The obligation of veracity is based on respect owed to others
⤷ Veracity has strong association of fidelity and keeping promises
⤷ Relationship of trust between persons are needed for successful intervention and cooperation

VIOLATIONS TO VERACITY
⤷ Omission that critical relevant facts are intentionally left out when disclosing the patient medical
condition
⤷ Commission means that the medical personnel intentionally tell the patient or her family a lie
⤷ Cover the truth in so much medical jargon

CONFIDENTIALITY
⤷ “Confidene” – to RUST
⤷ Refers to medical or professional secrecy in which certain information is committed to a physician
in an official capacity for the sake of medical assistance.

MORAL ISSUE
⤷ Conflict between the individual/patient interest and the interest of society.

Conditions to Justify the Violation of Confidentiality

⤷ When keeping the secret would be harmful to the common good
⤷ When the subject of the secret intends to inflict upon an innocent third party.
⤷ When it is necessary for the subject of the secret to avoid grave injury

APPLICATION OF ETHICAL THEORIES

Natural Law Ethics
⤷ Each individual is entitled to know the truth about himself/herself.
⤷ considers the necessity of withholding information from the patient on certain occasions for the
patient’s well being.
⤷ perceives that the relationship between physician and patient is one of TRUST and CONFIDENCE.
⤷ Physician has a duty NOT to betray the confidence of his patient. However such relationship is not
sacred and such duty is not absolute. If the physician’s perception a greater wrong or evil will be
committed by not divulging what the patient has confided, then the physician has the duty to
break that confidence

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ILLUSTRATION
⤷ The physician’s testimony is needed to acquit the patient from a terrible crime he did not
commit; it is the physician’s duty to make his/her testimony available, even if by doing so, the
patient’s secret will be revealed.

ROSS ETHICAL PRINCIPLE

⤷ Two conflicting prima facie duties
⤷ Physician’s duty to the Patient and to the State

KANTS ETHICS
⤷ Truth telling and confidentiality as absolute.
⤷ The physician has the duty to preserve confidentiality because keeping promises is an absolute
duty.
⤷ Truth telling, a patient is a person who is entitled to receive information about his condition no
matter how painful it is.

SITUATIONISM/Fletcher.
⤷ Whatever circumstances are, one should make one decision in the name of agapeic love or
concern for the welfare of the patient.

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