Moral Issue of Paternalism

Meng Tze/ Mencius

4 beginnings that differentiate man from beast

1. Feeling of helpfulness and commiseration

2. Feeling of shame and dislike

3. Feeling of modesty and yielding

4. Sense of right and wron

4 constant virtues

1. human-heartedness

2. Righteousness3. Propriety4. Wisdom“All men have a mind which

cannot bear to see the suffering of others…”

Paternalism• From the Latin word

– Paternos-father

• Acting like a father to a person for the latter’s own good and interest

• Intended to protect or advance the interest of its recipient, although such an act may go against the latter’s own immediate desires or may limit his freedom of choice.

TYPES OF PATERNALISM1. (WELFARE)

1. PURE PATERNALISM

2. IMPURE PATERNALISM

2. (RECIPIENT’S DEFECT AND SAFETY)

1. RESTRICTED2. EXTENDED

3. (PROMOTION OF GOOD AND PREVENTION OF HARM)

1. POSITIVE

2. NEGATIVE

4. (PATIENT’S SENSE OF VALUES)1. SOFT

2. HARD

5. (RECIPIENT OF THE BENEFIT)1. DIRECT2. INDIRECT

PURE PATERNALISM

• Justifies the intervention into a person’s life for the sole welfare of that person

• Ex.– Advising pregnant women to do

prenatal check-ups

IMPURE PATERNALISM

• Justifies interference with another person not only for that person’s welfare but also for the welfare of another

• Ex.– Parent of a JW should have a blood

transfusion for the good of the patient and the family

RESTRICTED

• Supports intervention which overrides an individual’s action because of some defect or weakness in that individual

• Example– Telling the mother of the child with

leukemia not to let his son play basketball

EXTENDED

• Individual is restrained form doing something because it is too risky

• Example– Not allowing the 5 year old boy to

ride on the horse by himself.

POSITIVE PATERNALISM

• Patient is forced into a rehabilitation program for his own good

• Example– Drug addict forced into the mental

asylum

NEGATIVE PATERNALISM

• Prevention of harm• Example

– Cigars and alcoholic beverages are taken away from an addict

Soft paternalism

• Patient’s values are used to justify the intervention with his possible action or decision

• Example– Comatose pt, is detaced form life-

support machines because of her advance directives

Hard Paternalism

• Patients’s values are not the ones used to justify a paternalistic act

• Example– Doctor decided to go on CS of a

CPD case.

DIRECT PATERNALISM

• Benefit will be to the recipient• Example

– Motorcyclist obliged to wear helmet

INDIRECT PATERNALISM

• Benefits will be to the person, if other person is restrained from doing something.

Medical Context

• Personal– individual

• State paternalism– By the government– Legislature– Agency

•All hospitals must hire only RN

JUSTIFICATIONS FOR PERSONAL PATERNALISM• The recipient of the paternalisic act is sick and

consults the physician for medical advice• The patient has some incapacity which prevents him

from making decisions– Nervous breakdown, minor, comatose

• The probable benefit of paternal intervention outweighs the probable risk of harm form non-interference

• Doctor has an obligation to act in the best interest of the patient

• The patient upon consulting the physician, voluntarily transfers part of his autonomy to the doctor base.

Jusfication of state paternalism• Improve good the quality of

medical education• Upgrade a high standard of

medical care• To control drug addicted, drug

abuses, spread of AIDS and sex related diseases

APPLICATION OF ETHICAL THEORIES• Natural law

– Endorses paternalism

• Kant’s ethics– Against paternalism

•States that the person is a rational and autonomous being, self-regulating will

•with exceptions, if the patient becomes unconscious then, the medical team should decide for the patient.

APPLICATION OF ETHICAL THEORIES• Rawl’s Ethics• Utilitarianism