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Paternalism v. autonomy - are we barking up the wrong tree?

Peter Lepping1, Tom Palmstierna2, Bevinahalli N Raveesh2

  • 1Peter Lepping, MSc, MD, MRCPsych, Wrexham Community Mental Health Team, Betsi Cadwaladr University Health Board, Ty Derbyn, Wrexham Maelor Hospital, Wrexham, Centre for Mental Health and Society, Bangor University, and Mysore Medical College and Research Institute, India; Tom Palmstierna, MD, PhD, Forensic Psychiatric Outpatient Unit, Stockholm Addiction Centre, Karolinska Institutet, Stockholm, Sweden, and Norwegian University of Science and Technology, Trondheim, Norway; Bevinahalli N. Raveesh, MSc, MD, MBA, LLB, LLM, Dharwad Institute of Mental Health and Neurosciences, India peter.lepping@wales.nhs.uk.

The British Journal of Psychiatry : the Journal of Mental Science
|August 3, 2016
PubMed
Summary

Increasing patient autonomy may not always reduce paternalism. Ethical values must be balanced dynamically, considering patient wishes alongside family and stakeholder needs over time.

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Area of Science:

  • Bioethics
  • Medical Ethics
  • Patient Autonomy

Background:

  • Paternalism in healthcare often conflicts with patient autonomy.
  • Existing ethical frameworks may prioritize autonomy without considering other values.

Discussion:

  • Autonomy should not automatically outweigh other ethical considerations.
  • Balancing patient autonomy with other ethical pillars requires a nuanced approach.
  • The optimal balance between patient wishes and stakeholder interests is context-dependent.

Key Insights:

  • Reducing paternalism is not solely achieved by enhancing patient autonomy.
  • Ethical decision-making requires dynamic consideration of multiple values.
  • Stakeholder involvement, including family, is crucial in healthcare ethics.

Outlook:

  • Future ethical models should incorporate dynamic balancing of values.
  • Research is needed on practical methods for achieving dynamic ethical balance.
  • This approach can lead to more patient-centered and ethically sound care.