Whenever I ask a question, my least favorite response is always “it depends”. I am constantly searching for the correct answer to each problem, and do not enjoy being told that, in some situations, there isn’t one. In regards to the debate of paternalism versus autonomy, the answer is quite often “it depends”. It is not possible to say that every use of medical paternalism is completely unjustified, because each situation, person, age group, motivation, and medical condition is different. Alan Goldman’s work focuses on how paternalism factors into these separate situations, showing just how complex the topic is. Goldman breaks his argument against paternalism into two sections: empirical and moral. In the empirical section, he brings up the point that it is impossible for physicians to know if patients will actually be negatively affected if they are fully informed. Physicians will not always properly calculate risk-benefit, so they should not have the power to decide for the patient, thus refuting the argument for paternalism. With this argument, though, the use of paternalism depends on the physician’s ability to understand the patient and their possible reactions. If there is a physician that is able to perfectly calculate the risk-benefit, and knows that the patient will be happier if they are kept in the dark, then paternalism would be justified.
When focusing on the moral argument, Goldman stresses the important role that personal values play in paternalism. The fundamental outline of paternalism is based on the idea that health and prolonged life take full priority over patients’ personal preferences. Many would argue that modern medicine’s goal is to prolong life, so physicians are simply doing their jobs by doing everything to keep their patients alive. Some patients value making their own decisions more than the length of their life, though. If a physician decides to withhold medical information or move forward with treatment, the patients that value self-determination will not have an improved quality of life. Goldman concludes his moral argument by saying that these values are present because they are upheld by rational beings that deserve to make personal decisions. Taking away a person’s ability to choose can threaten their individuality. In these specific instances, paternalism does seem to be morally wrong. In individuals that do value health and long life over decision making, a physician interfering with the patients’ liberty would be valid. Paternalism is therefore an issue that depends on individual values and situations.
Though Goldman primarily argues against it, he does acknowledge that paternalism can sometimes lead to good. There is no perfect example of an instance where paternalism should overrule autonomy, so the answer must be: “it depends”.