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Paternalistic Approach in Physician-Patient Relationships in Medical Care in the Light of Contemporary Ethical Theories and Principles of Bioethics

Received: 5 August 2022    Accepted: 26 August 2022    Published: 31 August 2022
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Abstract

Medical and health care are described as a relationship between physician and patient, where the patient’s concerns are presented. The role of the physician is to listen, reach a diagnosis and describe the appropriate treatment. National as well as international ethical guidelines encourage physicians to act in the best interest of the patient. In concept, this seems to do good (beneficence) for patients. For centuries, physician-patient relationships were based on unilateral decision-making which was always done by the doctor. This wrought medical paternalism. Medical paternalism is based on the basis that doctors and other medical workers are more knowledgeable about the human body and its health problems than the patients themselves. This idea clearly leads to the adoption of neglecting the opinion and desire of patients, i.e. the principle of respect for autonomy. In this article we discuss the concept of medical paternalism, its historical development, typology of medical paternalism, paternalism and ethical theories and arguments for and against medical paternalism. We conclude that medical paternalism is refused in contemporary medical practices because it is a usurpation of patients' autonomy. Instead, we suggest an integrated physician-patient relationship module. We suggest that a follow-up or future work on this topic should be made.

Published in American Journal of Health Research (Volume 10, Issue 4)
DOI 10.11648/j.ajhr.20221004.15
Page(s) 179-184
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Paternalism in Medical Field, Beneficence, Autonomy, Respect for Autonomy

References
[1] AMA Code of Ethics for Physicians (2016). accessible at: https://www.ama-assn.org/sites/default/files/media-browser/principles-of-medical-ethics.pdf
[2] Amer AB (2019). Understanding the Ethical Theories in Medical Practice. Open Journal of Nursing. Vol. 9 No. (2): P 188-93. DOI: 10.4236/ojn.2019.92018.
[3] Ayodele JA (2015). The Realities Surrounding the Applicability of Medical Paternalism in Nigeria. Global Journal of Social Sciences. Vol 14: 55-61.
[4] Bassford HA (1982). The justification of medical paternalism. Soc Sci Med. 16 (6): 731-9. doi: 10.1016/0277-9536(82)90464-6. PMID: 7089608.
[5] Beauchamp TL & McCullough LB (1984) Medical Ethics – The Moral Responsibilities of Physicians, Prentice-Hall., Inc., Englewood Cliffs, New Jersey, P. 22.
[6] Buchanan DR (2008). Autonomy, Paternalism, and Justice: Ethical Priorities. Am J Public Health. Vol 98, No (1): P15-21.
[7] Childress JF (2020) Paternalism in Healthcare and Health Policy in: Childress JF. Public Bioethics: Principles and Problems DOI: 10.1093/med/9780199798483.003.0003.
[8] Childress JF and Beauchamp TL (1982) Who Should Decide? Paternalism in Health Care (New York: Oxford University Press.
[9] Chin JJ (2002). Doctor-patient Relationship: from Medical Paternalism to Enhanced Autonomy. Singapore Med J. Vol 43 (3): 152-155.
[10] Drolet BC, and White CL (2012) Selective Paternalism. American Medical Association Journal of Ethics. Vol 14, (7): P 582-588.
[11] Elsayed DM (2006). National Framework for Ethics in Health Research Involving Human Subjects. Sudanese Journal of Public Health. Volume (1): No. 3. 192-196. Available from: http://www.sjph.net.sd
[12] Elsayed DE (2007). Public health and ethics: an overview. SJPH. Volume (2): 3. 146-151. Available from: http://www.sjph.net.sd
[13] Fernández-Ballesteros R, Sánchez-Izquierdo M, Olmos R, Huici C, Ribera Casado JM and Cruz Jentoft A (2019). Paternalism vs. Autonomy: Are They Alternative Types of Formal Care? Front. Psychol. 10: 1460. doi: 10.3389/fpsyg.2019.01460.
[14] Gillon R (1985). Paternalism and medical ethics. BMJ. Vol. 290. P 1971-72.
[15] Graboyes RF and Topol E (2017). “Anatomy and Atrophy of Medical Paternalism” (Mercatus Research, Mercatus Center at George Mason University, Arlington, VA.
[16] Holm S (2010) Ethical Issues in Geriatric Medicine in: Brock Elmhurst’s Textbook of Geriatric Medicine and Gerontology (Seventh Edition).
[17] Komrad MS (1983). A defense of medical paternalism: maximizing patients' autonomy. Journal of medical ethics. 9, 38-44.
[18] Lim L S (2002). Medical Paternalism Serves the Patient Best. Singapore Med J Vol 43 (3): 143-147.
[19] Mandal J, Ponnambath DK and Parija SC (2016). Utilitarian and deontological ethics in medicine. Trop Parasitol. 6 (1): 5-7. doi: 10.4103/2229-5070.175024.
[20] Monya De (2004). Towards Defining Paternalism in Medicine The theme editor introduces an issue focusing on paternalism in medical decision making. Virtual Mentor. Vol. 6, (2): P 55-7.
[21] Murgic L, Hébert PC, Sovic S & Pavlekovic G (2015). Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics 16: 65 DOI 10.1186/s12910-015-0059-z
[22] Pelto-Piri V, Engström K & Engström I (2013). Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care. BMC Medical Ethics. 14: 49. http://www.biomedcentral.com/1472-6939/14/49
[23] Rodriguez-Osorio CA & Dominguez-Cherit G (2008). Medical decision making: paternalism versus patient-centered (autonomous) care. Wolters Kluwer Health. Lippincott Williams & Wilkins. DOI: 10.1097/MCC.0b013e328315a611.
[24] Rosalind A (2009). A Compatible Defense of Respect for Autonomy and Medical Paternalism in the Context of Mental Capacity on the Grounds of Authenticity. UWSpace. http://hdl.handle.net/10012/4746
[25] Sudanese Medical Council, (2013) Medical Ethics Manual.
[26] Trout J. D (2007). A Restriction Maybe, but is it Paternalism? Cognitive Bias and Choosing Governmental Decision Aids. NYU Journal of Law & Liberty. Vol. 2: P 455-69.
[27] Umbeli T, Marium AA & Elhadi MA (2009). Implementation of Informed Consent in Obstetrics and Gynecology Operations in Khartoum- Sudan. Sudan JMS. Sept 2010; Vol. 5, No (3): p 173-177.
[28] Varkey B (2021). Principles of Clinical Ethics and Their Application to Practice. Med Princ Pract 30: 17–28.
[29] WMA (2005). Declaration of Lisbon on the Rights of the Patient 1984, amendment.
[30] Žitinski M (2012). Paternalism as a field of bioethical concern. JAHR. Vol. 3 No. (5): 165-75.
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  • APA Style

    Dya Eldin Mohammed Elsayed, Omsalama Diyaeldin Bakri. (2022). Paternalistic Approach in Physician-Patient Relationships in Medical Care in the Light of Contemporary Ethical Theories and Principles of Bioethics. American Journal of Health Research, 10(4), 179-184. https://doi.org/10.11648/j.ajhr.20221004.15

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    ACS Style

    Dya Eldin Mohammed Elsayed; Omsalama Diyaeldin Bakri. Paternalistic Approach in Physician-Patient Relationships in Medical Care in the Light of Contemporary Ethical Theories and Principles of Bioethics. Am. J. Health Res. 2022, 10(4), 179-184. doi: 10.11648/j.ajhr.20221004.15

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    AMA Style

    Dya Eldin Mohammed Elsayed, Omsalama Diyaeldin Bakri. Paternalistic Approach in Physician-Patient Relationships in Medical Care in the Light of Contemporary Ethical Theories and Principles of Bioethics. Am J Health Res. 2022;10(4):179-184. doi: 10.11648/j.ajhr.20221004.15

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  • @article{10.11648/j.ajhr.20221004.15,
      author = {Dya Eldin Mohammed Elsayed and Omsalama Diyaeldin Bakri},
      title = {Paternalistic Approach in Physician-Patient Relationships in Medical Care in the Light of Contemporary Ethical Theories and Principles of Bioethics},
      journal = {American Journal of Health Research},
      volume = {10},
      number = {4},
      pages = {179-184},
      doi = {10.11648/j.ajhr.20221004.15},
      url = {https://doi.org/10.11648/j.ajhr.20221004.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20221004.15},
      abstract = {Medical and health care are described as a relationship between physician and patient, where the patient’s concerns are presented. The role of the physician is to listen, reach a diagnosis and describe the appropriate treatment. National as well as international ethical guidelines encourage physicians to act in the best interest of the patient. In concept, this seems to do good (beneficence) for patients. For centuries, physician-patient relationships were based on unilateral decision-making which was always done by the doctor. This wrought medical paternalism. Medical paternalism is based on the basis that doctors and other medical workers are more knowledgeable about the human body and its health problems than the patients themselves. This idea clearly leads to the adoption of neglecting the opinion and desire of patients, i.e. the principle of respect for autonomy. In this article we discuss the concept of medical paternalism, its historical development, typology of medical paternalism, paternalism and ethical theories and arguments for and against medical paternalism. We conclude that medical paternalism is refused in contemporary medical practices because it is a usurpation of patients' autonomy. Instead, we suggest an integrated physician-patient relationship module. We suggest that a follow-up or future work on this topic should be made.},
     year = {2022}
    }
    

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    AU  - Dya Eldin Mohammed Elsayed
    AU  - Omsalama Diyaeldin Bakri
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    AB  - Medical and health care are described as a relationship between physician and patient, where the patient’s concerns are presented. The role of the physician is to listen, reach a diagnosis and describe the appropriate treatment. National as well as international ethical guidelines encourage physicians to act in the best interest of the patient. In concept, this seems to do good (beneficence) for patients. For centuries, physician-patient relationships were based on unilateral decision-making which was always done by the doctor. This wrought medical paternalism. Medical paternalism is based on the basis that doctors and other medical workers are more knowledgeable about the human body and its health problems than the patients themselves. This idea clearly leads to the adoption of neglecting the opinion and desire of patients, i.e. the principle of respect for autonomy. In this article we discuss the concept of medical paternalism, its historical development, typology of medical paternalism, paternalism and ethical theories and arguments for and against medical paternalism. We conclude that medical paternalism is refused in contemporary medical practices because it is a usurpation of patients' autonomy. Instead, we suggest an integrated physician-patient relationship module. We suggest that a follow-up or future work on this topic should be made.
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Author Information
  • Department of Community Medicine, Faculty of Medicine, Alzaiem Alazhari University, Khartoum North, Sudan

  • Department of Industrial Biotechnology, Council for Science and Technology, Sudan Academy for Science, Khartoum, Sudan

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