In “The Refutation of Medical Paternalism”, Goldman makes his case for why paternalism is often incorrect in the medical field, when dealing with patients. In addition, Goldman dives into the various arguments promoting Paternalism, their fundamental roots of understanding, and uses that to extract various counterarguments that disprove said advocations for paternalism in the medical field.
Goldman’s argument against paternalsim starts with the understanding that every individual has their own set of values that are often ranked differently compared to the next person. Not every person will value health over all other “priorities”. Many, as seen in case studies, will value their religious practices over their health, if the two contradict. That said, giving a physician, nurse, or any healthcare delivery professional the right to override their (aware/functioning) patient’s desires-whether disclosed by the patient or not-would be a complete violation of thier autonomy. This leans on the principle explained by Goldman, that in order for a medical professional to make such a decision, they would have to have a full psychological analysis of the patient, and a deep understanding of the patient’s values, which is nowhere near possible to do consistently and efficiently.
That said, Goldman’s passion is expressing the seriousness of not assuming what is best for the patient is a critical part of his argument against paternalism. Goldman suggests that although a medical professional may know what is medically best for a patient, opposing the patient’s wishes would be even more harmful to the patient because, in that moment, the patient knows what’s best for them. However, when patients are suffering and struggling with their illness, Goldman explains that if lying to the patient would help ease some of the patient’s mental suffering, it can be done, but cautiously and when with a thorough psychological evaluation of the patient, while being able to maintain the lie. This could be another method of protecting the interest of the patient since Goldman’s objective is essentially to do that.
In the above post, Mukarram analyzes Goldman’s argument to reduce paternalism in healthcare. He does an excellent job of highlighting the key points made by Goldman, chiefly a physician cannot determine medical care on behalf of a patient without infringing on their autonomy. Under a paternalistic lens, the only time a physician could make a proper determination of a patient’s wishes would be with a detailed psychological report, which would be impossible in practice. As a result, Goldman emphasizes that physicians should always consult the patients and follow their wishes, even if it goes what is “best” medically.
Personally, I agree with this philosophy as it most clearly gives autonomy to the patient, which is paramount in healthcare. When patients choose to interact with the healthcare system, they arrive seeking information to make decisions, not to bestow their ailments to physicians for their fascination. As a result, the goal of physicians and healthcare systems at large should ultimately be to enable patient autonomy. Granted, there will be situations where a patient’s choice will be infringed on (Ex. A trauma doctor doesn’t have the luxury to ask an unconscious patient about their preferred treatment). Nevertheless, as a general concept, reducing paternalism in healthcare is a step towards increasing autonomy.
That being said, I strongly disagree with Goldman’s proposal of lying to patients. Ignoring moral implications and working just in Goldman’s frame, to lie to a patient is to change the reality they are living in, making their imagined future decisions unpredictable. Individuals living in different realities cannot predict the wants or desires of the other. Thus, the patient must be fully informed of their health to make decisions. As I am just a college student, I’m sure Goldman had to think of this (or something similar) before he decided that lying was permissible. Consequently, I wonder what his logic was to arrive at such a conclusion. Moreover, the only stipulation he includes is that lying is okay to alleviate a patient’s mental suffering, but who is to judge proper mental suffering?