Avoiding Paternalism with Plato: Levin’s Doctor-Patient Tie

The truly collaborative relationship model between doctor and patient has so far been elusive. In Susan Levin’s paper, The Doctor-Patient Tie in Plato’s Laws: A Backdrop for Reflection, the author critiques two models proposed by Ezekiel and Linda Emanuel, and Edmund D. Pellegrino and David C. Thomasma. On review, both come close to striking the perfect balance, but ultimately fail. Their failures lie in the possibility for their models to become paternalistic which is thought of as a flawed model. In the paper, Levin proposes an approach of her own which adopt concepts from Plato’s Laws. In this essay I will argue that with the help of Plato’s ideas, Levin is able to create a model which distances itself from paternalism in ways that the other models could not and, in doing so, achieves a more collaborative relationship.

Patient autonomy was the predominant concern during the time of publication of both Ezekiel and Linda Emanuel, and Edmund D. Pellegrino and David C. Thomasma's texts. During that time, the paternalistic model, in which a doctor uses their skills to understand the disease and choose a best course of action for the patient to take, had been replaced by the informative model, one which centered around patient autonomy. The latter model featured a relationship where the control over medical decisions was solely given to the patient and the doctor was reduced to a technical expert. Pellegrino and Thomasma and the Emanuel’s found that the shift from one extreme, the paternalistic model, to the other, the informative model, did not adequately move towards an ideal model. The problem with the informative model, according to the Emanuel’s, is that the autonomy described is simple, which means the model “presupposes that p...

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...r away from the thread of paternalism because the doctor is not inclined or able to take advantage of the patient.

In studying Plato’s Law’s, Levin was able to find themes in the work to create a doctor-patient model which successfully moved away from that of the paternalistic model and include autonomy without leaving the patient. By recognizing and accounting for the fallibility that is innate in all humans, Levin is able to eliminate the problem of assumed moral knowledge. In shifting the possible power imbalance between doctor and patient by adopting a balanced asymmetry, the model avoids an unwarranted power divide that caused the downfall of the two models proposed by the Emmanuels’ and Pellegrino and Thomasma. Also, moral education is implemented to prevent doctors from having too much power and control, which aids in keeping clear of the paternalistic model.