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Paternalism has no Value in Healthcare

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Paternalism has no Value in Healthcare

Introduction

Paternalism refers to making choices or acting on behalf of another individual to

improve that person's well-being. The name comes from the Latin word for father, and a

paternalist decision is meant to mirror the kind of choice a caring parent would make on their

child's behalf. One must behave paternalistically only if one believes it would help the other

person. Choosing and carrying out actions for the advantage of the doctor or the healthcare

system, or with ambiguous motivations, are not paternalistic but rather coercive (Fernández-

Ballesteros et al., 2019).

When dealing with patients in a non-emergency setting, paternalistic decision-making

is seldom, if ever, justifiable. However, in an emergency, when the patient has no time to talk

with his physician or when dealing with public health, paternalism may be acceptable.

Although patients may be weak and susceptible, they have the right to make choices for

themselves if they want.

Keeping in mind the given scenario, I have decided to underpin this topic because it

enables me to think as if I am acting as a nurse should I leave the patient with his autonomy

to decide for his healthcare, or should I act paternally decide on the interest of patients when

they do not know their actual health condition and causes. The scenario is as given below,

Let's say I am a nurse, and I have just verified that a patient hospitalised to the

hospital due to a vehicle accident and pneumonia has cancer. Is it my duty to uphold the

patient's right to autonomy by disclosing the information to him and his loved ones, even if

the doctor thinks it would only make things worse and make everyone lose hope, or is it my

duty to comply with his wishes and keep the news to myself? As a nurse, I feel patients have

a right to all the facts to make educated choices, and withholding information violates that
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right. Of course, I want to do what is in the patient's best interest, and I think hiding these

facts from them is unethical and not what a practical nurse would do under these

circumstances. However, I am at a loss regarding how to handle the problem in such a

scenario appropriately.

Main Body

A strong doctor-patient connection is crucial for making treatment choices based on

the patient's best interests. Better (health) results have been linked to higher quality (of

communication) between doctors and patients (Tang, 2019). The doctor-patient relationship

is most successful when both parties actively work to improve it via open dialogue,

commitment, education, and care.

Consumerism, default, paternalism, and mutuality are the foundations upon which the

doctor-patient dynamic rests. When the patient and the physician are willing to share

information and expertise and work together to resolve conflicts, this is known as a

mutualistic relationship and is seen as the ideal situation for both parties involved.

Paternalism is a kind of physician-centred care in which the doctor makes decisions for the

patient based on his or her professional judgement rather than the patient's preferences.

Although the doctor thinks it is in the patient's best interest to wait to notify him about his

cancer until he is stronger and better, this is not always what the patient would have chosen

(Hofmann and Stanak, 2018).

During the early 1960s, doctors began considering patients' autonomy and permission

before making medical decisions, which helped alleviate some ethical problems associated

with paternalism. Growth in consumerism, the empowerment of women, and the passage of

legislation protecting patients' autonomy in medical decision-making all contributed to a shift

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away from paternalism. Patients requested more information regarding their health, well-

being, lifespan, and death rates to participate actively in their treatment. Consequently, there

was a rise in cases where a doctor was sued for failing to treat a patient properly. For the first

time, healthcare providers had to decide what information was most important for patients to

understand their illness (Hofmann and Stanak, 2018).

 Legal Justification

Using the patient as an example, the tension between the patient's legal and

paternalistic treatment has been clear. In contrast to moral paternalism, which bases choices

on ethical principles rather than rules and regulations enacted at the federal, state, or

municipal level, legal paternalism bases decisions on compliance with such laws and

regulations. When the doctor failed to provide information about the patient's condition—

which is now a legal requirement—the doctor was acting in violation of legal paternalism.

The doctor was engaging in moral paternalism when he tried to hide the patient's cancer

diagnosis from him, thinking that the patient would be unable to cope with the news and

make things worse (Saygili, Özer and Karakaya, 2020).

Today's paternalism issue centres on whether or not physicians should have the right

to make treatment decisions for their patients when they have reason to think the patients

would reject such a decision if given all relevant information. Is it reasonable for physicians

to proceed with therapy if they believe that their patients would benefit in the long run and

that, at some time, the patients will agree that the doctors' choices were appropriate? In

certain cases, it is hard to tell if a doctor's intervention is being done for the patient's benefit

or the doctor's, and it is also hard to tell whether the doctor is acting in good faith. Mills

firmly believes in individual freedom, defending her patients' rights. He maintains that

everyone is capable of figuring out what makes them happy and that the pursuit of one's own
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goals is a major contributor to that pleasure. Kant agrees with those who advocate for

patients' rights and maintains that everyone must know their autonomy (Tang, 2019).

The Patient Bills of Rights of 1973 mandated that doctors provide patients with as

much information as possible about their health and treatment options. The legislation was

enacted to lessen the frequency of malpractice by easing the ire of patients who fit the

conditions for increased culpability on the part of their doctors (PMC, n.d.). The patient must

be provided with sufficient, legally compliant medical information that is both voluntary and

voluntary to understand. A doctor may be guilty of a crime if he or she fails to get patient

permission after providing the necessary information.

The Consumer Bill of Rights and Responsibility Act was enacted in 1998 to

encourage individuals to take an active part in their health care by bolstering trust in the

healthcare system, aiding in the determination of what makes a good healthcare provider and

provider-patient relationship, and making patients aware of their rights and obligations in the

course of their treatment and subsequent rehabilitation. Several patient rights were

incorporated in the recommendations to ensure the highest possible standard of care was

provided (Nys, 2008).

 Identify Methods of Ethical Justification

As a nurse who adheres to the theory that a morally good deed leads to a positive end,

I reasoned that delaying the news of the patient's cancer diagnosis until he was better able to

cope with it would be in his best interest. If the patient knew the news, he or she would likely

lose hope and cease trying to live. To be morally justified, an action must have no other

justification than that it is following one's duty, according to deontological philosophy. While

it may seem like the correct thing to do to keep a patient from finding out that he has cancer if
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he thinks that doing so would increase his chances of survival, doing so may be in violation

of the regulations and responsibility of the doctor or nurse to notify the patient on facts

connected to his health (Hofmann and Stanak, 2018).

The situation involves several ethical concepts, including beneficence, non-

maleficence, loyalty, and autonomy. As a nurse, I must insist that the patient and his loved

ones be told the truth about what is happening. Since the patient does not know he has cancer,

this may damage him more. The sufferer may be able to identify therapies that can slow the

progression of cancer, giving him more time with his loved ones. In cases when a patient is

capable of making decisions regarding his or her health care, the doctor should respect the

patient's right to autonomy by not determining what information the patient should be given.

By not disclosing crucial facts to the patient, I risk losing his confidence and maybe

jeopardising our professional relationship as his healthcare professionals (Jansen and Wall,

2017).

 Identification of the Patient and other Important People's Priorities, Values,

Rights, and Responsibilities

If the doctor believes the patient can make healthcare choices, he must get the

patient's informed permission before proceeding. My professional obligation as a nurse is to

treat each patient with dignity and sensitivity while providing them with thorough

information about their medical condition and treatment options. The patient may have

selected a close relative as an authoritative decision-making individual to make choices about

his primary care centred on the patient's ethics, opinions, and preferences if he is determined

to be incompetent to make such decisions for himself. If the patient does not name a

surrogate, the best interest concept applies, and medical choices are made based on what

would be in the best interest of a rational patient under the circumstances. Those close to the
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sufferer will want updates on his condition and prognosis (Nys, 2008). His relatives may be

providing him care, so that they would need thorough training.

 Ethical Dilemma

As a nurse, I face a moral dilemma when faced with such a circumstance since both

possible courses of action are equally inadequate and exhibit contradictory testimony. Should

I, as a nurse, violate the patient's autonomy by not telling him that he has lung cancer even if

his doctor thinks it is in his best interest? Or should I escalate the situation and do all my

power to ensure the patient's healthcare, welfare, and rights are upheld?

Guidelines from the Code of Nursing and Midwifery Board of Ireland (NMBI)

From May 2021 forward, nurses and midwives in Ireland must adhere to a new Code

of Professional Conduct and Ethics drafted by the Nursing and Midwifery Board of Ireland

(NMBI). It is an update to the original edition, which came out in December 2014 and was

based on much feedback from people. Care for the patient safely, ethically, and effectively is

the primary focus of the Code, and it is meant to serve as a guide for your daily work (Nmbi.

i.e., 2014).

These are the principles that the Nursing and Midwifery Board of Ireland believe

should underlie nursing practice and serve as a starting point for developing a philosophy of

nursing:

1. Nursing practice choices should prioritise the patient's rights, needs, and overall benefit

and promote and maintain the best quality standards in health care services.
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2. Second, nurses treat everyone with dignity and compassion regardless of age, gender,

colour, ethnicity, religion, marital or familial status, sexual orientation, mental or physical

handicap, or affiliation with the Traveller community.

3. Third, the therapeutic connection between the patient and the nurse is essential to nursing

practice because it allows the patient to feel heard, understood, cared for, and able to make

decisions about his or her own life.

4. Nurses must advocate for their patients and their loved ones. Promoting nursing practice

within nursing's administrative and supervisory frameworks is also a part of this.

Conclusion

As a nurse, based on the information presented above, I must choose how to proceed

based on what I believe a reasonable nurse would do and then implement that decision per the

patient's preferences. If I want to protect his autonomy in medical matters, I will have to talk

to the doctor and explain his situation. If this cannot be settled, it is recommended that you

escalate the matter. The presented circumstance requires me to first attend to the desires and

requirements of the sufferer and then to those of his or her loved ones. That choice must be

respected if the patient desires not to undergo therapy. For example, if someone requests to

begin cancer treatment immediately, his preferences must be honoured. As a nurse, my first

line of defence is always to discuss the problem with the attending physician. If that does not

work, I will escalate the situation by bringing it to the attention of the nurse supervisor, who

will then face her superiors and maybe file a lawsuit based on the criteria set down in NMBI

2021.
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References

Fernández-Ballesteros, R., Sánchez-Izquierdo, M., Olmos, R., Huici, C., Ribera Casado, J.M.
and Cruz Jentoft, A. (2019). Paternalism vs. Autonomy: Are They Alternative Types
of Formal Care? Frontiers in Psychology, 10. doi:10.3389/fpsyg.2019.01460.

Hofmann, B. and Stanak, M. (2018). Nudging in screening: Literature review and ethical
guidance. Patient Education and Counseling, 101(9), pp.1561–1569.
doi:10.1016/j.pec.2018.03.021.

Jansen, L.A. and Wall, S. (2017). Reconsidering paternalism in clinical research. Bioethics,
32(1), pp.50–58. doi:10.1111/bioe.12382.

Nmbi.ie. (2014). NMBI - NMBI Scope of Practice: Nursing Practice. [online] Available at:
https://www.nmbi.ie/Standards-Guidance/Scope-of-Practice/Nursing-Practice-Scope-
Definition.

Nys, T.R.V. (2008). Paternalism in Public Health Care. Public Health Ethics, [online] 1(1),
pp.64–72. Available at:
https://www.jstor.org/stable/pdf/26644820.pdf?refreqid=excelsior%3Adc573ffaad35c
7faba5549893d374cf6&ab_segments=&origin=&acceptTC=1 [Accessed 1 Sep.
2022].

PMC, E. (n.d.). Europe PMC. [online] europepmc.org. Available at:

https://europepmc.org/article/nbk/nbk538279 [Accessed 1 Sep. 2022].

Saygili, M., Özer, Ö. and Karakaya, P.Ö. (2020). Paternalistic Leadership, Ethical Climate
and Performance in Health Staff. Hospital Topics, 98(1), pp.26–35.
doi:10.1080/00185868.2020.1726848.

Tang, L.-L. (2019). Emancipatory reflection on a nursing practice-based ethical issue about
nurses' paternalistic decision-making for patients. Frontiers of Nursing, 6(1), pp.19–
26. doi:10.2478/fon-2019-0005.