Moral issue of paternalism and truth telling


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Moral issue of paternalism and truth telling

  1. 1. Moral Issue of Paternalism
  2. 2. Meng Tze/ Mencius
  3. 3. 4 beginnings that differentiate man from beast <ul><li>Feeling of helpfulness and commiseration </li></ul><ul><li>Feeling of shame and dislike </li></ul><ul><li>Feeling of modesty and yielding </li></ul><ul><li>Sense of right and wron </li></ul>
  4. 4. 4 constant virtues <ul><li>human-heartedness </li></ul><ul><li>Righteousness </li></ul><ul><li>Propriety </li></ul><ul><li>Wisdom </li></ul><ul><li>“ All men have a mind which cannot bear to see the suffering of others…” </li></ul>
  5. 5. Paternalism <ul><li>From the Latin word </li></ul><ul><ul><li>Paternos-father </li></ul></ul><ul><li>Acting like a father to a person for the latter’s own good and interest </li></ul><ul><li>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. </li></ul>
  6. 6. TYPES OF PATERNALISM <ul><li>(WELFARE) </li></ul><ul><ul><li>PURE PATERNALISM </li></ul></ul><ul><ul><li>IMPURE PATERNALISM </li></ul></ul><ul><li>(RECIPIENT’S DEFECT AND SAFETY) </li></ul><ul><ul><li>RESTRICTED </li></ul></ul><ul><ul><li>EXTENDED </li></ul></ul><ul><li>(PROMOTION OF GOOD AND PREVENTION OF HARM) </li></ul><ul><ul><li>POSITIVE </li></ul></ul><ul><ul><li>NEGATIVE </li></ul></ul><ul><li>(PATIENT’S SENSE OF VALUES) </li></ul><ul><ul><li>SOFT </li></ul></ul><ul><ul><li>HARD </li></ul></ul><ul><li>(RECIPIENT OF THE BENEFIT) </li></ul><ul><ul><li>DIRECT </li></ul></ul><ul><ul><li>INDIRECT </li></ul></ul>
  7. 7. PURE PATERNALISM <ul><li>Justifies the intervention into a person’s life for the sole welfare of that person </li></ul><ul><li>Ex. </li></ul><ul><ul><li>Advising pregnant women to do prenatal check-ups </li></ul></ul>
  8. 8. IMPURE PATERNALISM <ul><li>Justifies interference with another person not only for that person’s welfare but also for the welfare of another </li></ul><ul><li>Ex. </li></ul><ul><ul><li>Parent of a JW should have a blood transfusion for the good of the patient and the family </li></ul></ul>
  9. 9. RESTRICTED <ul><li>Supports intervention which overrides an individual’s action because of some defect or weakness in that individual </li></ul><ul><li>Example </li></ul><ul><ul><li>Telling the mother of the child with leukemia not to let his son play basketball </li></ul></ul>
  10. 10. EXTENDED <ul><li>Individual is restrained form doing something because it is too risky </li></ul><ul><li>Example </li></ul><ul><ul><li>Not allowing the 5 year old boy to ride on the horse by himself. </li></ul></ul>
  11. 11. POSITIVE PATERNALISM <ul><li>Patient is forced into a rehabilitation program for his own good </li></ul><ul><li>Example </li></ul><ul><ul><li>Drug addict forced into the mental asylum </li></ul></ul>
  12. 12. NEGATIVE PATERNALISM <ul><li>Prevention of harm </li></ul><ul><li>Example </li></ul><ul><ul><li>Cigars and alcoholic beverages are taken away from an addict </li></ul></ul>
  13. 13. Soft paternalism <ul><li>Patient’s values are used to justify the intervention with his possible action or decision </li></ul><ul><li>Example </li></ul><ul><ul><li>Comatose pt, is detaced form life-support machines because of her advance directives </li></ul></ul>
  14. 14. Hard Paternalism <ul><li>Patients’s values are not the ones used to justify a paternalistic act </li></ul><ul><li>Example </li></ul><ul><ul><li>Doctor decided to go on CS of a CPD case. </li></ul></ul>
  15. 15. DIRECT PATERNALISM <ul><li>Benefit will be to the recipient </li></ul><ul><li>Example </li></ul><ul><ul><li>Motorcyclist obliged to wear helmet </li></ul></ul>
  16. 16. INDIRECT PATERNALISM <ul><li>Benefits will be to the person, if other person is restrained from doing something. </li></ul>
  17. 17. Medical Context <ul><li>Personal </li></ul><ul><ul><li>individual </li></ul></ul><ul><li>State paternalism </li></ul><ul><ul><li>By the government </li></ul></ul><ul><ul><li>Legislature </li></ul></ul><ul><ul><li>Agency </li></ul></ul><ul><ul><ul><li>All hospitals must hire only RN </li></ul></ul></ul>
  18. 18. JUSTIFICATIONS FOR PERSONAL PATERNALISM <ul><li>The recipient of the paternalisic act is sick and consults the physician for medical advice </li></ul><ul><li>The patient has some incapacity which prevents him from making decisions </li></ul><ul><ul><li>Nervous breakdown, minor, comatose </li></ul></ul><ul><li>The probable benefit of paternal intervention outweighs the probable risk of harm form non-interference </li></ul><ul><li>Doctor has an obligation to act in the best interest of the patient </li></ul><ul><li>The patient upon consulting the physician, voluntarily transfers part of his autonomy to the doctor base. </li></ul>
  19. 19. Jusfication of state paternalism <ul><li>Improve good the quality of medical education </li></ul><ul><li>Upgrade a high standard of medical care </li></ul><ul><li>To control drug addicted, drug abuses, spread of AIDS and sex related diseases </li></ul>
  20. 20. APPLICATION OF ETHICAL THEORIES <ul><li>Natural law </li></ul><ul><ul><li>Endorses paternalism </li></ul></ul><ul><li>Kant’s ethics </li></ul><ul><ul><li>Against paternalism </li></ul></ul><ul><ul><ul><li>States that the person is a rational and autonomous being, self-regulating will </li></ul></ul></ul><ul><ul><ul><li>with exceptions, if the patient becomes unconscious then, the medical team should decide for the patient. </li></ul></ul></ul>
  21. 21. APPLICATION OF ETHICAL THEORIES <ul><li>Rawl’s Ethics </li></ul><ul><li>Utilitarianism </li></ul>