Paternalism in nursing and healthcare: central issues and their relation to theory

Paternalistic practices, wherein providers confer a treatment or service upon a person or persons without their consent, ostensibly by reason of their limited autonomy or diminished capacity, are widespread in healthcare and in societies around the world. In the United States, paternalism in health and human services is widespread and probably increasing with newly emergent forms. Numerous issues surround paternalistic practices. In this column, the author examines these issues in relation to theory development in healthcare and nursing as well as theory as a guide to practice. It is suggested that scientific and ethical knowing are not separate but must be united in theoretical structures that include both in unity, along with an appreciation of the infinite complexity of life as it is humanly lived. It is also suggested that nursing's unique theory base of frameworks that honor human dignity and focus on human experience offers an opportunity for leadership in further developing theoretical frameworks that transcend paternalistic practices.