Medical Paternalism: Respect For Autonomy And Beneficence

Historically, medical paternalism was once the core ethical principle for physicians to practice medicine. Since the modern times, more and more people are getting close attention to patients’ rights when getting medical service, and medical paternalism has gradually aroused controversy. The current argumentation of medical paternalism mainly appears on its justification, with the focus on these two ethical values: respect for autonomy and beneficence. In this paper, I will further defend Alan Goldman’s position that medical paternalism should be refuted in some medical settings, in which the autonomous decisions made by once-competent but current incompetent persons should still be respected. Medical paternalism not only falsely views the

Goldman believes that nothing in the world can replace personal autonomy over important decisions in an individual’s life, while personal autonomy has independent values (Goldman, 1980). Autonomy means self-determination by a competent individual, with liberty and agency as its two basic conditions (Beauchamp & Childress, 2009). A competent individual’s autonomous decision should always be respected because it comes from the person’s reasonable thinking and considerations based on the person’s own values of life. The case of Mary C. Northern is a good example for it. In consideration of the limitations of the disability, she made a very different judgment from her physicians. She would rather choose to be at risk for death than have her legs amputated. No person other than the only particular individual can better know about the best interests for him or her. This is also supported by Bernice Elger when analyzing the case of Monica (Elger, 2000). Also, respect for autonomy has already been taken into account in the modernized version of Hippocratic Oath, “But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty” (Lasagna, 1964). Autonomy empowers an individual the right of making rational decisions when facing medical problems, so does the right to act accordingly to

It is considered a practice of beneficence by physicians because medical personnel uses their professional knowledge to make judgments on the patients’ interests and maintain those interests. Indeed, because of the asymmetry and inequality of professional knowledge and information, medical personnel are believed to be more authoritative than patients in the judgment of patients' medical benefits. However, medical interventions should not only involve the patient's medical benefits, but also other interests, such as freedom of religion and a pursuit of a certain way of life. Patients often need to make trade-offs among conflicting interests, and the balance should be based on the patients’ perspective. In this respect, patients are best qualified to speak on this question than the medical personnel. Without the independent will of the patients, the best patients’ interests cannot be judged rationally. However, medical paternalism forms judgments of patients' medical benefits from the medical personnel’ point of view rather than from the patients’