Paternalism is the practice of acting as the “parent,” which is taking it upon oneself to make decisions for the patient. Years ago the “doctor knows best” approach regarding treatment was common. The doctor merely picked a course of treatment he or she thought was best for the patient. Of course, paternalism is not acceptable today because it eliminates patients’ right to choose the treatment they feel is right for them, even if their choice is not what the doctor feels is best. Here is an example of paternalism. The patient is given a treatment plan of extracting a painful tooth and fabricating a three-unit bridge for tooth replacement. Due to the patient’s age, the dentist feels this is the easiest approach so the tooth will not give the patient any problems in the future. In this case, there is no mention of possible endodontic treatment or replacing the extracted tooth (if extraction is required) with an implant.
Paternalism violates this patient’s autonomy and self-determination, and ethically involves nonmaleficence due to not giving the patient the right to informed consent; thus, paternalism is the opposite of informed consent. This patient did not have all the information needed to make an informed decision for care. Informed consent is highly recommended for today’s progressive medical and dental treatment. This allows for patient autonomy, self-determination, and beneficence, thus avoiding paternalism. Dental offices, like medical offices, are able to “provide patients a financial estimate for prostheses and other treatments,” and even have patients sign a document acknowledging their financial agreement.
This agreement helps patients understand their alternatives regarding treatment. The agreement may even state estimates relating to each treatment option. Informed consent requires opening the lines of communication between provider (dentist or hygienist) and patients. The provider needs to make sure patients understand their options, and patients then acknowledge they have all the information, benefits, and risks along with their financial obligation. Interestingly, many providers do not take into account the pain people will experience as an ethical problem — “for some, pain still seems to be only a technical problem solved by treatment.” Pain is an ethical concern for patients and should be incorporated into the informed consent information when presenting options for patients. Pain can have a substantial effect on the treatment options patients consider.