Medical paternalism and patient autonomy

Abstract

As a philosopher, my intention in writing this thesis .is to perform a linguistic task which is both analytic and diagnostic in regard to a conception of the professional role of medical practitioners. Especially in the context of the fatally-ill patient, but also in other areas where the recent sophistication of advanced medical technology has created a broad spectrum of life-prolonging and survival possibilities, I propose to determine under what circumstances a medical practitioner ever is justified in acting against or ignoring what his patient wants him to do. The label 11 medical paternaism embodies an heuristic device for identifying a certain cluster of practices and core-beliefs extrapolated from professional medical codes in which the decisions of patients appear to be (unduly) usurped by the medical practitioner. The thrust of the above delineation of medical paternal ism is contained in Chapters Two and Three which discuss topics such as incompetence and medical expertise respectively. Professional medical codes, such as the Oath of Hippocrates, the Oath of Maimonides, The A.M.A. Code of Ethics, and the C.M.A. Code, are used by medical practitioners as a post facto justification of their behavior in often agonizing and complex treatment situations for which they were never designed, and indeed, could never have anticipated. Modern scientific discoveries and their rapid technological applications in medicine have rendered anachronistic the traditional conceptual framework for patient treatment. There is a widening gap in the input into medical decision-making processes, between what medical practitioners do with their high-powered expertise and the patient's putative right to a unique role in the decision-making process affecting him, especially in regard to such items as sophisticated life-prolonging technology. Some of the crucial issues generated by the rise of medical technology in regard to the patient's autonomy are explored in depth in my chapter on personal autonomy. The old medical codes yield an interpretation of the doctor/patient relationship which is flatly contrary to my understanding of a logically viable account . For example, one core-belief among advocates of medical paternalism is that the doctor, in his role as medical expert, may exercise the authority to administer or withdraw a specific medical treatment against the consent of the patient. A second core-belief consists in the view that perceived conflicts between the codes and the decisions of patients regarding medical treatments must be resolved in favor of the codes. It is the two-fold aim of my thesis to dethrone this appeal to the codes and to suggest that something must be done in order to provide a clear conceptual apparatus for dealing with ethical issues which have been generated by recent, sophisticated advances in medical technology. I do not simply wish to say that the codes are antiquated or non-specific, for I argue that the basic presuppositions, the underlying beliefs upon which the codes have been built, must be rejected. am not concerned to decry the alleged moral evils of medical paternalism. Instead, I address myself to the analytic task of revealing the sins against logic (in the form of inconsistency, incoherence, unjustifiable assumption, invalid inference, etc.) that dedication to the extant codes perpetuates in regard to decision-making processes. Finally, I sketch a model for a revised code which more nearly accommodates my logical scruples.