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The inherent paternalism in clinical practice
1Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, Denmark.
The Journal of Medicine and Philosophy
|June 1, 1995
Summary
The physician’s “adviser model” of simply presenting facts is unrealistic. Clinical reasoning inherently blends facts with values, necessitating physician-patient trust and acknowledging inherent paternalism.
Area of Science:
- Medical Ethics
- Clinical Decision-Making
- Philosophy of Medicine
Background:
- The "adviser model" suggests physicians present objective facts and options, leaving choices solely to patients.
- This approach is often proposed as a value-free method for patient autonomy.
Observation:
- This paper examines the realism of the adviser model in clinical practice.
- Clinical reasoning involves complex biological, empirical, empathic/hermeneutic, and ethical components.
- Ethical norms in Nordic public health services provide a framework for discussion.
Findings:
- The adviser model is deemed unrealistic due to the intricate nature of clinical reasoning.
- Separating factual information from value judgments in patient communication is impossible.
- Clinical decision-making inherently contains paternalistic elements.
Implications:
- Effective patient information requires acknowledging the interplay of facts and values.
- Mutual trust between physician and patient is a cornerstone of clinical practice.
- The complexity of clinical reasoning challenges purely autonomous patient choice models.