Compare And Contrast Goldman's Arguments Against Medical Paternalism

Most people have probably heard the phrase “what works for one person may not work for another.” It turns out that this also applies to preferences in medical care. Because of the advancements in medical ethics, patient care is no longer strictly based on a doctor’s directive. Goldman, a proponent of patient autonomy asserts that medical paternalism is never warranted by setting out two arguments against medical paternalism. The first argument he sets forth is empirical, the other, moral. While Goldman’s stance on the refutation of medical paternalism is strong from a moral standpoint it is not so much on secure on empirical grounds. To understand this further, it is necessary to clarify the two positions Goldman has presented on his refutation

of medical paternalism.
Before defining the two arguments it is vital to first discuss the definition of harm. Harm is what Goldman presents to drive his point about medical paternalism being unjust. Goldman says that, “a person is harmed when a state of affairs below a certain level on his preference scale is realized rather than going one up” (Goldman 104). According to Goldman, people have a “preference scale.” That scale is associated with their personal likes and dislikes, and is basically what drives them to live their lives as they see fit. Goldman describes harm as a relative notion (105). Simply put, he says that anything that tips the scale closer to an action that one would not deem to be favorable compared to their own personal value scale is considered harmful to them. What is interesting is that a person does not have to know if they are being harmed in order to be harmed. The inconsistency here is that Goldman does not provide a threshold that can be clearly defined. Therefore, there is no way of knowing exactly when that threshold is approached. Goldman describes this as, the empirical theory. The empirical theory also holds that respecting a patient’s rights will not harm the patient.
On the moral ground, Goldman says that, “If our primary goal were always to minimize risk to health and life, we should spend our entire federal budget on health-care areas” (107). This, Goldman says, easily demonstrates that the loss of life is not of the utmost importance to some people and not all decisions we make are based off of what will keep us alive longer, but rather, it is the quality of life that matters. Additionally, depending on person’s situation, health and living might not be as appealing as others would perceive it to be (105). Here, there are many factors to consider, such as, the quality of life, financial status, and an assortment of other factors-- each changing from patient to patient. Again, we would have to take into consideration the patient’s desires. Yet again, this is an issue that Goldman says we cannot make assumptions about because we cannot fathom what the patient perceives to be a life worth living.
Ironically, it is this, respecting the patient’s rights, that may actually harm the patient. Which, in this case, Goldman says is okay because the patient has chosen this for himself. This harm can play out in a number of ways. Take for example, a cancer patient who is unwilling to go through a treatment that may or may not work, we can assume the patient’s doctor has disclosed the fact that the treatment itself could be life altering resulting in a number of negative side effects. Given this information, and after weighing options, the patient decides to forego treatment altogether in order to live out the rest of their life as comfortable as possible. This, Goldman explains, is the right of the patient to choose for himself the course of his medical care, and one that needs to and in this case, has been protected. No matter the outcome the patient remains autonomous and the doctor, regardless of what his position is, has no right to interfere with this decision. Therefore, the patient’s right to self-determination has been protected. Goldman claims that not respecting the patient’s autonomy or giving them the opportunity to make their own decisions ultimately harms them further. An example of this is a when a doctor makes the recommendations but conveniently leaves out other alternatives that could sway a patient’s decision from the doctor’s preferred recommendation. The foundation of Goldman’s moral argument is that harm is harmful all the time especially if it prohibits the development or hinders the ability of a person to make decisions. A general thing to consider here is that, if we could live with the same actions being taken against us, or have a decision made for us without disputing it then it would be acceptable. But because each person values things in different ways Goldman says that paternalism can never morally be sanctioned.
On the refutation of medical paternalism, Goldman’s claim on moral grounds seems strong. His stance that it is wrong to obstruct in any way the autonomy of a person who is fully capable of making decisions for themselves makes sense. Yet, Goldman has not considered that not all people are capable of autonomy. Think of the intellectually challenged, elderly people with deteriorating conditions such as dementia, or even a person who suffers from a traumatic brain injury. These cases are extreme examples but very realistic realities for some individuals and their families. No matter how we look at it decisions regarding health care for patients in this capacity will eventually require a doctor to intervene to do what is best for the patient in the long run. Ultimately, this is what creates a fallacy on the moral end of Goldman’s argument. This also shows why it is important to consider the argument that paternalism is sometimes justified.
In closing, Goldman’s argument against medical paternalism presents two core things, one is that a patient has the right to know and take part in decisions regarding his own medical care regardless of the outcome and the other is ensuring that this right is not infringed upon in any way by health care providers.

“ Personal autonomy over important decisions in one’s life, the ability to attempt to realize one’s own value ordering, is indeed so important that normally no amount of other goods pleasures or avoidance of personal evils can take precedence.” The ultimate goal here is for the patient to remain autonomous. Contrary to what physicians thought of patients in the past, most patients today do want to know the status of their health, and can use this information to live their lives in a way that is the most meaningful to them. Withholding such information not only prohibits a patient from making fully informed healthcare decisions but it also violates the patient’s rights. In short, there is no way of ever knowing a person’s value scale, or what gives them reason to live the way they choose to. Although it can be argued that disclosure of certain information being given to a patient regarding health could induce anxiety or uncertainty. In the end, it is their right to know about the information because it is a necessary element that is required to make decisions regarding their healthcare. On that note, there are various other situations in life that can produce the same feelings mentioned before, regardless, as humans we tend to take chances with everything we do without ever fully knowing the results until we are faced with them. Autonomy is a fundamental right that allows us to make these decisions for ourselves. Without it, we are powerless to make decisions for

ourselves.