Paternalism in Medicine: When Should We Override Patient Choice?

[@empichel5690]

I searched for this video after having my rights violated by a nurse. Thanks for putting this content out. I looked it up later and she went against the state law, international accord, and acog recommendation in favor of her personal opinion. It really also decreased the likelihood I'll go to a hospital when I need it.

[@bettierusso5410]

Paternalism in Medicine is NEVER appropriate. I am an adult. I have the right to make decisions regarding MY HEALTH. A twenty-something Dr. can not understand what it feels like to have knowledge of what it is to grow older. Either "weak" or "strong Paternalistic" is always interfering and removing another person's personal right to decide what is right or wrong in their own life. I am a 30 yr Critical Nurse and have seen a lot. If a pt can speak, if they say "NO"...that is IT! I do not believe any Dr or medical care professional can or should decide to ignore the pt. After what I have seen, and what I now know as an older adult, I will stay away from a hospital at all costs because I do not trust them in any way. The gap in age is at the core of this discourse. At the beginning of adult life, a person does not have any understanding of what actually happens in the middle and end of the life of adulthood. There is very defiantly a power play at work here. Just because a young Dr says it is right to control the life decisions of a pt, does NOT make his decision and his opinion right. Ultimately, the only one that should have a deciding decision in the acceptance of a doctor's Dx and treatment is the final decision of the Pt. Age & medical personal Bias in medicine will defiantly influence these decisions. A PATIENT'S CARE IS DIRECTLY DEPENDENT UPON THE MORALS & PERSONAL ETHICS OF THE CAREGIVER. Will you think the same when you are in your 60s, 70s, or older?

[@FronteirWolf]

What about if someone's mental health condition is making them a danger to themself of others?

[@dr.dragan]

Should we let patients entirely decide if their pain warrants opioids?

[@bettierusso5410]

@@dr.dragan Yes.I do think it should be the pt. However, there are those who just want the narc and I understand that is not right...but, the person who has come to you in pain is asking for help..HELP. Drs need to remember..you work for ME, and I am paying exaggerated fees to talk to a Dr. YOU WORK FOR US!

[@dr.dragan]

@@bettierusso5410 doctors work for, not only the patient, but society at large. There is still a degree of soft paternalism involved in the current shared-decision making model with good reason; non-maleficence. Examples where soft paternalism upholds the tenant of non-maleficence - don’t give opioids like lollies just because a patient wants them (but in your view paternalism here is “never appropriate”) - don’t offer asymptomatic full body scans (incidentaloma harm, resource misuse in the public setting) - a patient is deemed not competent (psychosis, obtunded, intellectually disabled or unconscious) - someone at risk of harming themselves or others are scheduled/sectioned for their safety Would you just let the patient do whatever they wanted in these situations?

[@ugyenwangchuk8625]

Usually, weak paternalism seems to be justifiable

[@FronteirWolf]

It was suggested that I take fluoxetine as part of treatment for anorexia, I didn't want to take it at first because I was so worried about side effects. I never felt forced, like they did their best to persuade me and gave me time to think about it and I ultimately agreed to take it. They also wanted me to gain weight, I didn't want to that and spent weeks being told I had to gain weight and that they were considering admitting me. I was also told that I was in control, no one was going to force me to eat, I had to decide that for myself. I was repeatedly told I was in the drivers seat. I started to recover and I was very much allowed to recover in my own way. I counted calories upwards gradually like 100 more each week. It was unorthodox I think, I haven't heard of anyone else using that method to recover. There was another point where the doctors wanted me to take something and I didn't want to take it. I had managed to end up in hospital this time and again I never felt forced to take it. Again I was persuaded too. It was maybe halfway paternalistic to put so much effort into persuading me to do something, I think it was appropriate though, but it also really helped knowing that I wasn't being forced and that I felt somewhat in control. It wouldn't have been helpful to ignore my wishes and force me to take x or force feed me etc. I think my autonomy was overruled when it came to being admitted to hospital, I co operated fully, I wanted to be admitted, but I have a feeling it was happening no matter what.

[@vishusingh6913]

Outstanding explanation of this topic sir 👏👏 Thank you so much for this video♥️

[@fredphilippi8388]

Showing respect and giving adequate consideration to a doctor who has scientific knowledge by patients who do not have a scientific education is not yielding to paternalism. It is wise. Doctors should assume most patients have sufficient mental capacity to make decisions for themselves unless a mental health professional verifies their incapacity. Most patients know what is best for them, and what options of care they wish to pursue. Adults should indicate in an Advance Healthcare Directive (also called a LIving Will or a POLST document) what kind of medical care they would like to have if they lose mental capacity. In this way doctors and family members will know what the patient would wish.

[@colinm366]

Great presentation- Concise but thorough!

[@TheMultimoha]

My natural response to paternalism in medicine a couple of years ago would’ve been for it to not be practiced at all. However, after learning the true meaning of this concept, I changed my mind. Any discussion about paternalism should always start with a definition of the two types of paternalism that were discussed - weak paternalism and strong paternalism. Weak paternalism is much easier to digest and understand. There are many situations in which weak paternalism could be justified. The same cannot be said for strong paternalism. There might be some situations where we can make the argument for strong paternalism, but I personally can’t justify taking away a patient’s choice in order to simply benefit the patient. Although I appreciate O’Neill’s proposal of acting paternalistically in proportion to how diminished patients’ decision-making capacities are, I do not agree with it. As a patient’s decision-making ability declines, paternalism should not increase proportionally. Instead, as a patient’s decision-making ability declines, the physician should seek to work with the patient’s caretakers and do what the patient would’ve wanted. Physicians should not be alone in making decisions for their patients as O’Neill suggests.

[@bettierusso5410]

The new Covid-19 hospital rules of NO visitors have removed the Pt's "third party" to help make decisions in the care of their family member. There are no personal patient advocates in care and Paternalism rears its ugly head. I have even seen staff refuse to follow the pt's written DNR and do whatever they want, and I have seen staff end up in fights over pt care.

[@musicobsessed95]

This is definitely an important issue and discussion to have. It is true that with hospital restrictions- whether it is due to Covid-19 or general hospital visitor policies, it can cause there to be a lack of individuals present to advocate for the patient when necessary. This then can lead to a greater reliance on the patient's medical records and medical judgement by physicians/hospital staff in regards to the patient's care. This can lead to outcomes that do not follow the patient's wishes/medical directives Hospital ethics boards/committees can help to mitigate some of these concerns, but are not full proof.

[@JohnDo-r5x]

@@musicobsessed95 Hopefully, COVID hospital rules are behind us for good but I don't think patient advocacy is necessarily just from the patient's family. Physicians are trained to be their patient's advocates. In fact, I believe it is a part of the physician's duty to be an advocate for the patient. Let's not forget that there have been plenty of times when a physician was more of an advocate for a patient's interests than their own family members. A family member isn't necessarily obligated to look after the interests of a family member who becomes a patient. As for patient wishes/medical directives such as a DNR, these should be honored but if there are any doubts about it, I think it is best to save the patient so that a discussion can occur at a later time.

[@philipollas2377]

The problem is that it is hard to measure decision making ability, right? Doctors will also have unconscious biases. Who will be paternalistic towards the paternalist? O'Neills Essay is a useful general rule for many cases, but does not seem to me to be sufficient. Any thoughts?

[@RamoVlog]

Perfect explained very well

[@LadiJadi72]

Thank you for the clear language! This was worth watching!

[@Roxy-gn8dj]

Omm M M

[@atillabobb3070]

this was so helpful. thank you very much.

[@lisetterivera2133]

thank you

[@naeemsaid2759]

Thanks alots

[@Tamarcmhahealthmentor]

Laura's here

[@seymourgonzaga3232]

nice

[@baljeetkaur-jg7pr]

well explained..

[@bioethicsondemand6258]

Thanks! :-)

[@mitchelllott]

🙏🙏

[@donericdeartaadams6541]

4+32 into 5+32

[@donericdeartaadams6541]

Newable law

[@HaroutBlack]

Jesus says "I am the way, the truth and the life, no man comes to the father but by me" John 14:6. "whoever calls upon the name of the Lord (Jesus Christ) shall be saved" Romans 10:13 although we followed darkness Jesus toke our sins on the cross and died for us while we were living against him. Perfect example of paternalism. Now because of Jesus lives are changed and restored,

[@donericdeartaadams6541]

I stop eating junk food 1556 healthyer

[@NOODLEDOC1]

I wonder if O’Neil would be OK with forcing individuals with lower than average IQs to do what they do not want to do. I mean, one could make the argument that they have diminished capacity and thus are not in a position to make proper decisions. The logical extension to this is, whoever is the smarter person has the right to decide for the other.