ADVIENTO, Amanda Grace L.

ESPARAGO, Maria Julia Values and Professional Ethics

BSN 1-3
PATERNALISM

Patient Autonomy
Emphasizes procedure and the right of patients to decide for themselves. It considers
patient values as decisive.
The right of patients to make decisions about their medical care without their health care
provider trying to influence the decision. It allow for health care providers to educate the patient
but does not allow the health care provider to make the decision for the patient.
Communitarianism is a social theory that places “communal values, the common good, social
goals, traditional practices and cooperative virtues” (Beauchamp & Childress, 2001, p. 362)
above individualism.
For example, for the welfare of all citizens in the United States, children are required to be
immunized for certain communicable diseases prior to entering public school. There are risks
associated with immunizations, and parents are mandated to have their children immunized.
There are exceptions to this mandate, such as when the immunization is contraindicated for a
specic child or if parents have religious objection to vaccinations (state statutes describe what
is required to obtain exemption for school entry).Another example of communitarianism taking
precedent over autonomy occurs with so-called direct-observation therapy (DOT).In DOT
persons with a communicable disease such as tuberculosis are observed as they ingest oral
medication; if they do not agree to the DOT, they may, as a last resort and only through a court
order, be involuntarily isolated. Their autonomy and freedom would be sacriced to prevent the
spread of a communicable disease.
Paternalism
Involves making judgments about the best interests of others. Conict can arise, however,
when the nurse and the health care provider do not agree on what constitutes best interests as
well as whose best interests should be considered.
Paternalism takes on a new meaning when applied to a population versus an individual
client. Restricting the autonomy of a person or group of people for the protection of others
requires paternalism that is enforced by law, for example, public health initiatives requiring
immunizations, restriction on sales of alcohol and tobacco, and speed limits are mandated.
There are numerous decisions by the courts and legislature have caused physicians to
modify their behavior. Massachusetts (13) and California (14) now have laws requiring patients
with breast cancer to be provided with 'complete information on all alternative treatments which
are medically viable' (13). A number of cases (15) have affirmed the obligation to take a
patient's views into account in making decisions, and have reminded physicians about the
controversial nature of what is best for a patient. The law has also set limits on paternalistic
actions; physicians generally may not initiate treatment without the patient's informed consent.
Modern Paternalism
Today's physician must ascertain the values and interests of the patient. Because active patient
participation produces better results, he will usually inform or instruct the patient. His goal is to
improve care rather than promote patient autonomy.
Second, formal decision-analysis is unfamiliar to most patients, whereas physicians are trained
in problem-solving. Thus, armed with adequate information about a patient's values, the
physician may be in a better position to decide effectively what is best for the patient than the
patient even if he has been informed of all the medical information and then makes his own
decision. Although understanding a patient and his values fully may be difficult (and perhaps
impossible) for the physician, patients may find understanding either the scientific basis for their
treatment or the underlying motivations that influence their own decisions equally difficult.
Finally, the physician is likely to be more objective about the patient than the patient will be
about himself.
Decisional Capacity
When a client makes a decision that would appear to jeopardize his or her health or
welfare, the nurse might question the client’s ability to make decisions.
Parental Autonomy
It gives parents a wide berth in making decisions for their children. The parents are
responsible for the well-being of their child.
Family Paternalism
Nurses, acting in the best interests of the client, are sometimes asked by families to
provide treatment that the client is refusing. Valuing autonomy is weighed against other values,
such as comfort, truth telling, and family cohesion

Medical paternalism
It is to act without consent or override a person’s wishes, wants, or actions, in order to
benefit the patient or prevent harm to him or her (43).
It was also defined as the interference by the physician with the patient's freedom of action,
justified on the grounds of the patient's best interests. An example from a journal of medical
ethics is that some physicians would not inform patients of their condition or some medical
procedures because of their reaction as well as potentially refusing the procedure that could
save their lives. However, this was only done in the past.

There are two things that can ​determine whether overriding a patient’s autonomous
preference, or medical paternalism, is justified or not.
First, ​strong paternalism​, the of a competent patient’s explicit wishes, is generally rejected
since it violates autonomoverridingy. It falsely presumes independent knowledge of what is best
for the patient and falsely presuppose that there is a clear, objective set of values governing
such decisions (44). This is linked to the patient’s right to informed consent. As a result, patients
have the right to refuse treatment (48). The right to refuse treatment might be limited, however,
in court by appeal to parental obligations or in extreme cases suicide laws (Hall-Ellman, 268 ff.),
or in case the autonomy interest at stake is weak in comparison to the benefit to the patient
(Beauchamp and Childress, 282-83). An exception to this condition is when the patient’s culture
goes against a medical procedure or treatment since the patient’s autonomy would be stronger.

Second, ​weak paternalism​, acting for the benefit of an incompetent patient, is justified in some
cases in order to restore that person’s competence, or in order to protect a confused patient
from harm (45). It is best that the physicians or the health care providers decide what is best for
that patient.

Pre-test

1. It emphasizes procedure and the right of patients to decide for themselves.

A. Paternalism
B. Patient Autonomy
C. Decisional Capacity
2. It involves making judgments about the best interests of others.
A. Paternalism
B. Parental Autonomy
C. Decisional Capacity
3. A social theory that places “communal values, the common good, social goals, traditional
practices and cooperative virtues”.
A. Strong Paternalism
B. Modern Paternalism
C. Communitarianism
4. A kind of paternalism where today’s physician must ascertain the values and interests of
the patient.
A. Family Paternalism
B. Modern Paternalism
C. Medical Paternalism
5. It is questioned when a client makes a decision that would appear to jeopardize his or
her health or welfare.
A. Decisional Capacity
B. Parental Autonomy
C. Weak Paternalism
6. It gives parents a wide berth in making decisions for their children.
A. Family Paternalism
 B. Strong Paternalism
C. Parental Autonomy
7. It is to act without consent or override a person’s wishes, wants, or actions, in order to
benefit the patient or prevent harm to him or her.
A. Medical Paternalism
B. Patient Autonomy
C. Parental Autonomy
8. It is a kind of paternalism where nurses, acting in the best interests of the client, are
sometimes asked by families to provide treatment that the client is refusing.
A. Medical Paternalism
B. Family Paternalism
C. Modern Paternalism
9. It falsely presumes independent knowledge of what is best for the patient and falsely
presuppose that there is a clear, objective set of values governing such decisions.
A. Parental Autonomy
B. Patient Autonomy
C. Strong Paternalism
10. It is acting for the benefit of an incompetent patient.
A. Strong Paternalism
B. Patient Autonomy
C. Weak Paternalism

Post test
1. It emphasizes procedure and the right of patients to decide for themselves. ​Patient
Autonomy
2. A social theory that places “communal values, the common good, social goals, traditional
practices and cooperative virtues”. ​Communitarianism
3. It involves making judgments about the best interests of others. ​Paternalism
4. A kind of paternalism where today’s physician must ascertain the values and interests of
the patient. ​Modern Paternalism
5. It is questioned when a client makes a decision that would appear to jeopardize his or
her health or welfare. ​Decisional Capacity
6. It gives parents a wide berth in making decisions for their children.​ Parental Autonomy
7. It is a kind of paternalism where nurses, acting in the best interests of the client, are
sometimes asked by families to provide treatment that the client is refusing.​ Family
Paternalism
8. It is to act without consent or override a person’s wishes, wants, or actions, in order to
benefit the patient or prevent harm to him or her. ​Medical Paternalism
9. It falsely presumes independent knowledge of what is best for the patient and falsely
presuppose that there is a clear, objective set of values governing such decisions.
Strong Paternalism
10. It is acting for the benefit of an incompetent patient. ​Weak Paternalism