Alan Goldman's The Refutation Of Medical Paternalism

For the purpose of this case study, I will specifically examine the ethical issues of medical paternalism and deception-to-benefit-the-patient and whether their use can be viewed as justifiable. The act of “overriding a person’s actions or decision-making for his [or her] own good” or paternalism exercised by Dr. Haveford by choosing not to disclose all information to his patient can be evaluated through both the empirical and moral arguments against paternalism argued by Alan Goldman’s “The Refutation of Medical Paternalism” (Vaughn). It is mentioned that the doctor withheld information about clinical trials because he did not what to overwhelm the patient or cause her to experience emotional harm and, thus, he was acting in the best interest of his patient despite being aware of her value for honesty in their

relationship. However, grounded in the empirical argument, such an act of nondisclosure cannot be seen as a means to protect a patient from harm and that it is actually honoring a patient’s right to self-determination by disclosing all information that does not inflict harm onto him or her (Goldman).

Therefore, despite having prior knowledge of the uncertainty that arouse in Janet when presented with a lot of information, Dr. Haveford should have honored her right to self-determination with awareness that disclosing all information would not cause harm to her. In addition, from the moral counterargument against paternalism it is made apparent that harm could come to the patient due to a physician honoring their autonomy by disclosing information, but despite the possibility of harm overriding their right is still not warranted (Goldman). When Dr. Haveford came to the conclusion that the disclosure of all information about clinical trials would ultimately harm Janet, he failed to take into account the “most inclusive notion [that] harm is relative to the values and preferences of the particular individual” (Goldman). Hence, what may be considered harm to him

(i.e. diminished quality of life and emotional stress) may have not been considered harm to the patient. Although Dr. Haveford may have agreed with Goldman against the fundamentally faulty premise of medical paternalism, which “assumes that health and prolonged life must take absolute priority in the patient’s value orderings,” it may have been that the patient’s values actually aligned with this premise (Goldman). It was the doctor who wrongly assumed that quality of life is more important to his patient that longevity of life itself when choosing not to disclose about the clinical trials, essentially stripping Janet from truly exercising self-determination regarding her choices in treatment that would align with her own values and preferences. The patient may have valued life as intrinsic in itself enlisting in a clinical trial with drugs that may have allowed her to live ten additional years, which could have consisted of being bedridden and depressed. Therefore, paternalism was unjustified because Dr. Haveford may have incorrectly assumed his patient’s value ordering and, thus, only Janet had “the ability to realize [her] own values ordering” regarding her treatment options (Goldman).