Alan Goldman’s piece, ‘A Refutation of Medical Paternalism’, contains an argument for why medical paternalism is wrong. Goldman argues from the idea of ‘The Relativity of Value.’ Explain this particular argument and show how it is an argument against medical paternalism (be sure to first define what medical paternalism is). Do you think this argument is correct? Why or why not?
In biomedical ethics, the concept of patient autonomy versus is a huge consideration. This autonomy is often contrasted with what is called medical paternalism. Medical paternalism refers to physicians acting in regards to what they feel is best for the patient without much regard to the patient’s true wishes. It is the intervention of an individual’s right of action justified by reasons referring to the welfare and/or interest of that individual. While medical paternalism may be seen as positive, many refute it. In Goldman’s paper, “A Refutation of Medical Paternalism,” he talks about why medical paternalism is wrong.
Goldman refutes medical paternalism by introducing various arguments that support his case. One aspect of his argument lies in the following claim regarding the relativity of values: “The fundamental faulty premise in the argument for paternalistic role differentiation for doctors is that which assumes that health or prolonged life must take absolute priority in the patient’s value orderings” (67). Goldman states that in reality, individuals do not consistently act in order to minimize loss of life although the long-term preference is to live long. If individuals did prioritize minimum loss of life constantly, all efforts would be strictly directed towards health-related areas. This is not the case, for “to realize or preserve those values that give meaning to life is worth the risk of life itself” (68). Therefore, Goldman states that it is illogical for a doctor to determine what is best for the patient when such doctor cannot speak for what the patient’s set of values and priorities.
While a doctor believes health is number one in priority, the individual may not always hold health as number one at all times. The second aspect to Goldman’s argument is centered on the value of self-determination. He argues that, as stated before, a doctor cannot truly know the true interests of his patient, and at times, the patient may or may not even know his or her own interests. Because of this uncertainty, the doctor is less likely than the patient to make the right decision. “We value the exercise of free choice itself in personally important decisions, no matter what the effects of those decisions upon other satisfactions” (70). When choices are important to our lives, we like to know we have the ability to have some control over them. When a doctor holds the reigns of a patient’s well being without the patient’s say, it is hard to say that the decision made is fair. I personally concur with Goldman and the arguments he presents. I can see both sides to the argument; I can see why medical paternalism can be beneficial in some cases, but I can see why overall it is a basic intervening of an individual’s autonomy.
In the defense of medical paternalism, one can argue that it is expected of the medical practitioner to do what is best for his or her patient. However, as Goldman states, what does the practitioner know of what is best for a patient? For example, a patient may be in need for a blood transfusion. Yet if the patient happens to be a follower of the Jehovah’s Witness, the physician can’t possibly force the patient to take the transfusion, for it directly goes against the patient’s beliefs. I believe that although doctors may medically have an idea as to what is best for an individual, what is important is for the individual to comply, for it is his or her body that is being affected.