DOES THE PATIENT WANT AUTONOMY OR BENEFICENCE
(PATERNALISM), OR BOTH?
Dr. Christine Castle, Medical Ethicist and Chief of Internal Medicare at the University
of Chicago Medical Center, points out that it may, at times, be hard for the one to
engage in truly autonomous decision making at the very moment when sickness
saps your energy and impairs your freedom. This happens whether you are suffering
from a minor sickness like a sore throat or a broken leg, concerned that you might
have AIDS, or in terrible fear of cancer. She refers to a poignant article entitled, "On
Arrogance," written by a terminally ill physician for one of the professional journals.
The physician, suffering from terminal cancer and technically competent to make
treatment decisions, soon realized that what he really wanted was a knowledgeable,
ethical, competent person helping him to make decisions. He didn't want total
freedom or a menu of possible treatments similar to what one might receive from an
auto mechanic. He wanted someone with an opinion on the best possible treatment;
someone with whom to share the responsibility for decisions; someone who cared.
Or, Castle observes that there is no way the relationship between physician and
patient can be equal. The patient is dependent upon the physician for so many
things, from a prescription to a note to miss a day of work, to all the bureaucratic
being free and uncoerced we lose sight of the need for caring. Of course, the patient
wants to be treated with respect, and does not want his or her options unduly
constrained. But, at the same time, the patient wants a caring physician who is
ready to share in the responsibility?
beneficence: the concept that the role of the health care provider is to care for the
patient, to do good.
paternalism: the practice of treating people in an authoritarian manner, especially
by taking care of their needs without giving them any responsibility for health care