The Practice Of Paternalism By Atul Gawande

All medical providers, whether a physician, nurse or other professional, all are inspired by the Hippocratic Oath, as it instills the duty of beneficence towards patients as well as acknowledges the principle of doing no harm. Thus the provider must use his or her medical expertise and knowledge to promote or restore the patient’s health, focusing on identifying and diagnosing and treating illnesses, all while providing quality care. Paternalism has been one of the traditional characteristics of the relationship between the patient and their healthcare provider, however it suffers harshly from criticism, as the patients' rights movement and the reevaluation of professional authority has transformed. Many critics have argued against
In his novel Schneider sorted through a numerous studies on medical decision-making. The main outcome was that ill patients were often in a poor position to make good decisions. Thus supporting the idea of weak paternalism as certain patients are deemed incompetent due to illness itself or out of irrational emotion (fear or depression) and cannot act autonomously, let alone make major medical decisions. In his study, Schneider found that physicians who are less emotionally engaged are able to reason with patients without the distortions of fear and attachment. They work in a scientific culture that disciplines the way they make decisions, which include identifying the best possible outcome for the patient, which often includes the patient’s informed opinion. They have the benefit of ‘group rationality’ which are norms based on scholarly literature, refined practice and relevant
Howe, who was hospitalized following an operation for a badly infected gallbladder. Three days after his surgery, he spiked a high fever and become short of breath. The diagnosis was sepsis, a pneumonia, and the probability that he would get worse before he got better. Antibiotics would fix the problem, but not instantly, and in order to get better he would need to be placed on a breathing machine. He instantly refused and medical professionals informed him that without the ventilator he would die. He still refused and soon fell unconscious. That is when his physician took action and slipped a breathing tube into his trachea against his wishes. Within twenty-four hours, his lungs improved remarkably. When Howe awoke the tubes were removed, he looked up at Gawande and said “Thank you” (pg 91). This is also an example of strong paternalism as Mr. Howe was substantially autonomous. While many may argue that the physician in this case was wrong as she violated the right of Mr. Howe’s decision and did what she thought was right, however if she would of followed her patient’s decision, she would have robbed him of his life. Interference can be justified in this case due to the medical provider returning control and autonomy to their