How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making

Abstract

We conducted an empirical study to explore clinician and lay opinions on the acceptability of physician paternalism. Respondents read a vignette describing a patient with brain hemorrhage facing urgent surgery that would be lifesaving but would result in long-term severe disability. Cases were randomized to show either low or high surrogate distress and certain or uncertain prognosis, with respondents rating the acceptability of not offering brain surgery. Clinicians (N = 169) were more likely than nonclinicians (N = 649) to find the doctor withholding surgery acceptable (30.2% vs. 11.4%, p ≤ 0.001). Among clinicians, the doctor withholding surgery was more acceptable when prognosis was certain to be poor (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.04, 4.01). There was no effect of surrogate distress on clinician ratings. Responses among lay public were more variable. Given the differences in attitudes across clinicians and lay public, there is an ongoing need to engage stakeholders in the process of end-of-life decision making.

End-of-Life Care Decision-Making in Stroke

“…Given these considerations, clinicians should approach the decision-making process collaboratively, negotiating the role of the clinician with surrogates ( 98 ) rather than taking a default paternalistic approach ( 99 ). Though few providers enquire about the surrogate's preferred role in decision-making ( 98 ), providers should ascertain a decision-maker's preferred level of control over EOL care decisions.…”

Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions

“…However, one recent study found that paternalistic decision‐making (and prioritising technical expertise) when clinicians, patients and their families disagree had far less support among the lay public than among clinicians, highlighting how ideas of ethical decision‐making may differ between clinicians and those they treat (Bailoor et al . ).…”

In Defense of Patient Autonomy in Kidney Failure Care When Treatment Choices Are Limited

“…Such unilateral decision making, however benevolent its justification, is now widely considered anathema in the context of patient care, despite occasional calls for more nuanced consideration of the potential role and value of particular forms of paternalism in some contexts. [8][9][10] Respect for autonomy and, specifically, the ethical and legal requirement to obtain valid consent for treatment or participation in research, is considered a vital protection for patients.…”