Paternalism in the Name of Autonomy

Sjöstrand, Manne; Eriksson, Stefan; Juth, Niklas; Helgesson, Gert

doi:10.1093/jmp/jht049

Cited by 42 publications

(44 citation statements)

References 10 publications

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“…If an understanding of benefits and risks is to inform a patient's choice, then, in order to support the competency conditions necessary for the exercise of relational autonomy, it seems that the physician is obliged to provide information regarding the benefits and harms of the available options. However, if a patient suggests that they wish to make a decision based on other values, if they provide reasons for their treatment decision that express these other values or if they ask for details of probable benefits and potential harms to be withheld, then a physician would not be obligated to provide those details even if the absence of such information results in a less informed decision (p. 718) . This may seem problematic to proponents of SDM.…”

Section: Does Sdm Respect Procedural Approaches To Relational Autonomy?mentioning

confidence: 99%

Does shared decision making respect a patient's relational autonomy?

Lewis

2019

Evaluation Clinical Practice

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According to many of its proponents, shared decision making (“SDM”) is the right way to interpret the clinician‐patient relationship because it respects patient autonomy in decision‐making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy.

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Section: Does Sdm Respect Procedural Approaches To Relational Autonomy?mentioning

confidence: 99%

Does shared decision making respect a patient's relational autonomy?

Lewis

2019

Evaluation Clinical Practice

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“…This belief undermines reproductive autonomy in both the senses outlined above. In the Boption and decision^sense, in order for a choice to be autonomous, correct information is necessary (Beauchamp and Childress 1994;Sjöstrand et al 2013). John Stuart Mill (2003, 158) provides an example of a man about to cross a damaged bridge.…”

Section: Gender Essentialism Threatens Reproductive Autonomymentioning

confidence: 99%

How Sex Selection Undermines Reproductive Autonomy

Browne

2017

Bioethical Inquiry

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Non-medical sex selection is premised on the notion that the sexes are not interchangeable. Studies of individuals who undergo sex selection for non-medical reasons, or who have a preference for a son or daughter, show that they assume their child will conform to the stereotypical roles and norms associated with their sex. However, the evidence currently available has not succeeded in showing that the gender traits and inclinations sought are caused by a "male brain" or a "female brain". Therefore, as far as we know, there is no biological reason why parents cannot have the kind of parenting experience they seek with a child of any sex. Yet gender essentialism, a set of unfounded assumptions about the sexes which pervade society and underpin sexism, prevents parents from realising this freedom. In other words, unfounded assumptions about gender constrain not only a child's autonomy, but also the parent's. To date, reproductive autonomy in relation to sex selection has predominantly been regarded merely as the freedom to choose the sex of one's child. This paper points to at least two interpretations of reproductive autonomy and argues that sex selection, by being premised on gender essentialism and/or the social pressure on parents to ensure their children conform to gender norms, undermines reproductive autonomy on both accounts.

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“…This kind of reasoning might be described as paternalism in the name of autonomy or paternalism in disguise 17 18…”

Section: How and Why Physicians Are Restrictive In Offering Sedation mentioning

confidence: 99%

“…Medical paternalism, however, is no longer acceptable according to healthcare laws and ethical principles: respecting patients’ autonomy and shared decision-making are nowadays part of the official values. If a physician still embraces a paternalistic attitude when making decisions, he/she could question the competency of the patient and apparently exercise weak paternalism—although it might more correctly be referred to as paternalism in the name of autonomy or paternalism in disguise 17 18…”

Section: How and Why Physicians Are Restrictive In Offering Sedation mentioning

confidence: 99%

“…Today, paternalistic attitudes towards competent patients are difficult to defend openly and therefore competent patients are probably merely exposed to paternalism in disguise 18. Compared with the abortion-restricting physicians during the 1950s, palliative-care physicians today seem to be slightly more sophisticated if, for example, they succeed in caring about patients’ autonomy and at the same time tacitly avoid respecting it 16 17…”

Section: Comparison Of Abortion and Sedation Therapymentioning

confidence: 99%

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Physicians’ practices when frustrating patients’ needs: a comparative study of restrictiveness in offering abortion and sedation therapy: Table 1

Lynøe

2013

J Med Ethics

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In this paper it is argued that physicians' restrictive attitudes in offering abortions during 1946-1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians' values influenced their assessment of the facts presented--that is, the women's' trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It is also argued that a similar tacit practice could currently be applied by palliative care physicians. Such practice might allow palliative care physicians to be restrictive when offering sedation therapy without appearing paternalistic or declaring conscientious objections. However, the practice runs counter to patients' right to participate in making decisions. The women seeking abortion began to oppose the situation and eventually a new abortion law was introduced 1975. Patients at the end of life will never be able to protest against palliative care physicians' restrictive attitudes. This is a vulnerable and weak group, unable to lodge complaints after the treatment. In order to respect patients' autonomy, even suffering patients at the end of their lives, it is suggested that physicians should openly declare their values when it comes to providing treatments that might shorten life. Such transparency might facilitate more genuine shared decision-making and accordingly less suboptimal end-of-life care.

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Paternalism in the Name of Autonomy

Cited by 42 publications

References 10 publications

Does shared decision making respect a patient's relational autonomy?

Does shared decision making respect a patient's relational autonomy?

How Sex Selection Undermines Reproductive Autonomy

Physicians’ practices when frustrating patients’ needs: a comparative study of restrictiveness in offering abortion and sedation therapy: Table 1

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