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  1. 1. Paternalism Dato’ Dr. Ahmad Tajuddin Jaafar Allianze College of Medical Sciences
  2. 2. Definition - acting for the good of another person in a way that a parent might act for the good of their child.
  3. 3. Assumption - the person acting paternally is wiser, more knowledgeable and experienced than the person they act for and this justifies taking charge.
  4. 4. In Medicine, the assumption is that doctors are more experts then patients
  5. 5. <ul><li>Two kinds of paternalism; </li></ul><ul><ul><li>Strong Paternalism </li></ul></ul><ul><ul><li>Weak Paternalism </li></ul></ul>
  6. 6. <ul><li>Strong Paternalism </li></ul><ul><li>intentionally override patient’s wishes openly or through deception </li></ul><ul><li>Morally unacceptable. </li></ul><ul><li>Should be rare and limited to a situation in which there is no other way of managing a situation and in which the person is in danger of serious harm if the doctor does not act. </li></ul>
  7. 7. <ul><li>Weak Paternalism </li></ul><ul><li>Commoner in practice </li></ul><ul><li>This is assuming that patient is unable to understand medical information or deciding ‘not to worry’ with information that doctor think is burdensome to patient. </li></ul><ul><li>The assumption is paternalistic </li></ul>
  8. 8. <ul><li>Justification for Paternalism </li></ul><ul><li>Vulnerability of the sick </li></ul><ul><li>Medical expertise </li></ul><ul><li>Medical confidence and placebo effect </li></ul>
  9. 9. <ul><li>1. The vulnerability of the sick </li></ul><ul><li>too ill to discuss relevant information or make decision </li></ul>
  10. 10. Paternalism creeps in when there is unilateral decision by doctors that the patient does not need to know or would be better off not knowing
  11. 11. <ul><ul><ul><li>Even if the diagnosis is serious, most medical decisions are not urgent. There is still time to face the diagnosis, talk about patients belief and wishes. </li></ul></ul></ul>
  12. 12. The desire to spare patients uncertainty and fear can lead to paternalism.
  13. 13. <ul><li>Medical expertise </li></ul><ul><li>Many view that medical expertise and only doctors should decide for patients. </li></ul><ul><li>Assumptions; medical decisions are mainly scientific/technical in nature. </li></ul>
  14. 14. Fact is: the answer depends on the values that patient puts on various factors e.g. dissatisfaction with present therapy, needs to remain at work, indignation to take risks and the waiting list for different therapies.
  15. 15. <ul><li>3. Medical confidence and placebo effect </li></ul><ul><li>Revolves around the idea that it is important for doctors to act confidently, as faith in the doctor is good for patients </li></ul>
  16. 16. Assumption: disclosure of uncertainty is a bad thing for patients, and that uncertainty decreases doctors effectiveness as healers.