Culture of paternalism in the emergency department: a critical ethnographic study

Paternalism refers to the act of overriding an individual's preferences or decisions under the justification of acting in their best interest or protecting them from harm. When paternalistic care is delivered, it can result in adverse physical, psychological, and social consequences for patients. This study aimed to describe, interpret, and critically examine the culture of paternalism within the context of the emergency department.

This critical ethnographic study was conducted in the emergency department of a public hospital in Khorasan Razavi Province, Iran. The research followed Carspecken's method of critical ethnography, encompassing three preliminary and five main stages. Data were collected through participant observation, in-depth interviews, and document analysis to uncover the beliefs, values, actions, and power dynamics that reinforce paternalistic structures within the emergency care setting. Over 22 months of field work, empirical data were gathered and subsequently analyzed using reconstructive analysis. The identified systemic relationships were then interpreted in light of relevant sociological theories.

Analysis of the data led to the identification of four categories: domination of the superior, facilitation of the domination of the superior, destruction of the inferior, and the echoes of paternalism.

The findings indicate the presence of an entrenched culture of paternalism in the emergency department-one that poses significant challenges to delivering humane and ethically grounded patient care. These results underscore the need to raise awareness among healthcare providers regarding the ethical dimensions of clinical interactions and to enhance their understanding of the social and legal issues related to patient care. Ultimately, such awareness can inform strategies to recognize and address structural barriers, promote respect for patient autonomy, and support adherence to patients' rights.