Kindle Notes & Highlights
How Has the Shift from Paternalism to Autonomy Shaped Bioethics?
What is paternalism in general?
paternalistic restrictions of liberty
promote the well-being of those very individuals whose liberty is restricted.
criminal law, for example, is to prevent harm to others,
“the harm principle.”
examples are reasonably regarded as falling under paternalism, it should be noted that harm principle justifications can also often be given for them.
COVID vaccine or mask mandates
imposes. If vaccine mandates were an instance of paternalism, those who absolutely reject all paternalistic restrictions on freedom could reject them. But they aren’t,
How do strong and weak paternalism differ?
Paternalistic laws are particularly offensive when they force individuals to act contrary to their own values.
“strong paternalism.”
“weak paternalism.”
even if a ban on smoking in individual offices cannot be justified on harm principle grounds, it might be justifiable as an instance of weak paternalism.
whether a prohibition is the most effective way to get people to do what is in their own best interest.
education
“nud...
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What is medical paternalism?
medical decisions are not purely a matter of science but are value laden.
When physicians and patients differ on values, respect for autonomy requires that the values of the patient prevail.
What does autonomy mean in bioethics?
capacity
ability to make important and complex choices. This requires certain cognitive capacities, including the ability to understand information and appreciate its significance, to reason and weigh options, and to determine which choices best reflect the agent’s own values.
right:
but a right to autonomy does not depend on a high level of these capacities. All that is required is that the individual has the capacities of an adult with relatively normal intelligence.
What is informed consent?
What are the two parts of the doctrine of informed consent?
a legalistic approach to informed consent distorts the doctor–patient relationship
“Did you consent that patient?”
What was the significance of the Belmont Report?
What historical forces led to the rejection of medical paternalism?
civil rights movement, the women’s movement, and the so-called student movement
Do the effects of serious illness justify medical paternalism?
Do irrational choices justify medical paternalism?
fear.
fallacies
odds
Does respect for cultural differences justify deception?
prefer to know the truth
Trust,
How should doctors give bad news to patients?
the “informative model”
it is devoid of the trust and caring that is essential to the doctor–patient relationship.
deliberative model
physicians first give information on the patient’s clinical situation and then discuss with patients in a real dialogue the health-related values embodied in the various options.
These conversations, however, are not just chat but are some of the most important aspects of treating patients with serious and terminal illnesses.
Is deception justified in some “hard cases”?
unless doctors know that a particular patient wants to be protected from knowing the truth, they should speak frankly, albeit sensitively, about the diagnosis, prognosis, and treatment options.
Consider the case of Monica,
her life expectancy predicted to be about 3 months. Should doctors reduce her sedation enough to discuss treatment options with her (“wake her up”) or maintain her sedation to keep her comfortable?
