Paternalism: Medical or otherwise

Abstract

While the practice of medicine is ideally suited for the expression of paternalism, outside of the age-appropriate parent-child relationship, such expression is clearly inappropriate.

Previous publications concerning medical paternalism fail to consider the deep psychosocial roots of paternalism. As a result, there is no differentiation between appropriate physician attitudes of parental concern and inappropriate, uncounscious paternalism. Psychoanalysis, as a paradigmatic method of treatment, focuses on distinguishing inappropriate, transference-countertransference attitudes, from realistic physician and patient expectations.

It is not paternalistic to empathically withold information from patients. Rather, this is sensible and skillful medical practice. What is unconscionable, is a ‘father knows best’ physicianly attitude which is chronically and inappropriately applied and justified. This is poor patient care and clearly unethical.