A commentary on Dworkin’s Paternalism

Gerald Dworkin, a philosophical pioneer of the idea of paternalism, argues that there may exist parameters where a person, in present time, may not want to partake in a particular action, but at another time, may understand the positives of said action and agree to others paternalistically forcing them to commit said action. This avenue of thought paves way for paternalistic legislation and governance, which pervades common contemporary society. Laws and rules are put in place for the benefit of all whom reside within the law’s jurisdiction. Seeking out every citizen’s approval before instating society-wide limitations or practices, like taxes or drug illicitation, is near impossible in growing societies, which begins a path of instability for Dworkin’s framework of paternalistic governing. This framework proves potentially unethical to assuage a platform of limitation to the masses without formally taking into account the value prioritization of those who are being affected on a constant and rolling basis. Paternalism would then only be validated in scenarios which there is no class or hierarchy system associated with the beneficiaries of any said law or restriction. Dworkin defines this subsidiary of paternalism as Pure paternalism. In the same vein of thought, Dworkin would argue that patients who provide consent to treatment in the beginning stages of treatment, are powerless to refuse or halt care if the practicing physician deems the patient to have lost rationality in the process. There is no certainty within that assumption, which provides more room for grey area in the conversation of the morality of medical paternalism. How can one be certain that a doctor, who is getting paid for performing any said procedure or treatment, has no implicit or explicit biases that influence their decision of continuing on with a patient’s care. An alternative process that should be considered for evaluative and medical ethicality is one where the patient is provided with many opportunities to express their distaste in continuing treatment, upon which ethical conclusions may be drawn as to what next steps to take, as opposed to forcing the patient to assimilate with whatever the physician decides as best. 

1 thought on “A commentary on Dworkin’s Paternalism

  1. Justin Owen

    A patient may lose their ability to make certain decisions, if any, if they are deemed to have lost all rational thought, but this is important so that they do not make life-threatening decisions when they can not even think properly. Whether they are under the influence, or have altered mental status, they can not make proper decisions based on anything, even outside of healthcare. That is why physicians utilize next of kin, so they can make those proper decisions for them, but if no next of kin can be provided, the physician will have to make the best possible choice, in their opinion, that will benefit the patient the most, not their paycheck. Most physicians are not paid by procedure also, as they are paid by salary, at least for employed physicians, but the number of employed physicians recently surpassed the number of private practice physicians. There may be that implicit bias for the private practice physician as they will get a bigger check, but the decision is still up to the patient, if they are not inebreated, to choose which procedure or treatment, if any is best for them. The one idea that is praised, and utilized heavily within healthcare, is informed consent. This is so the patient knows exactly what the procedure or treatment entails, and knows of any risks that are involved and they may be provided alternatives if they so choose. If the patient is unable to make such decisions, and no next of kin is able to be reached, the physician may utilize implied consent, which is consent that the physician deems best for the patient. Some bias may exist, but we do not live in a perfect world and some physicians may take advantage of this but that does not mean all physicians should be generalized by the act of a few.


Leave a Reply to Justin Owen Cancel reply

Your email address will not be published.