Argument for Consensual Paternalism in Shared Decision-Making: Rediscovering Autonomy in Western Bioethics

Western bioethics has evolved from discussions centered around paternalism and individual autonomy to the concept of Shared Decision-Making (SDM). This approach to decision-making aims to uphold patients' autonomy while prioritizing open communication and collaboration. When it comes to making decisions for infants or children, both parents and pediatricians share the responsibility. Parents' personal experiences, values, and beliefs play a central role in the concept of SDM. However, there is still ongoing debate regarding whether physicians should convey their own values, preferences, and recommendations. In Pakistan, clinical decision-making is predominantly the domain of physicians. Physicians are regarded as figures of respect and authority, and seeking a physician's opinion is common. In a patrilineal and family-oriented society, medical paternalism is accepted and valued by patients and their families. Autonomy is viewed through a different lens in this cultural setting. This paper presents a narrative analysis of the contrasting approaches to clinical decision-making in these two cultural contexts. It raises thought-provoking questions about how clinicians navigate decision-making dynamics, particularly when faced with different expectations from patients and families. The juxtaposition of these approaches prompts reflection on the potential impact of cultural and societal norms on ethical considerations in healthcare. The paper criticizes the moral hegemony of autonomy and argues for rethinking the separation of autonomy and paternalism in Western bioethics, offering Consensual Paternalism, which represents shared yet unconventional decision-making.