The reading on “Libertarian Paternalism” takes a concept that has for years been seen in a negative light and gives it a positive spin (Thaler and Sunstein). When discussing the history of health care and public health in America especially, the concept of paternalism is typically thrown around in tones of disgust and shame. Authority figures in the realm of health aren’t qualified to decide what is best for us—only we are capable of making those decisions.
In our discussions surrounding informed consent and autonomy, we continuously mulled over whether or not health care professionals have the right to make decisions or even narrow down treatment options for patients. I have come to the conclusion that they largely do have this authority and duty. Though the model of the doctor/patient relationship could use some serious work, patients do not need to know about each option available to them; being informed is important, but doctors are capable of narrowing down treatment options without full patient partnership.
Thaler and Sunstein take this question of the morality of paternalism to a different level. They use examples of a less immediate nature such as retirement plans and cafeteria layouts to illustrate the unavoidable nature of paternalism and just how beneficial it can be, suggesting that we not focus on whether or not paternalism is right in certain cases but how to choose the best paternalistic options.
Though the examples they use are simple, I believe Thaler and Sunstein have a point regarding paternalism in public health. People will most often do what is best for themselves. Public health is the improvement and maintenance of the health of communities, not the individual—thus it is not beneficial to rely upon individuals to make effective decisions in public health.
What is interesting to me, though, is that this argument can then stand as a counterargument in the informed consent and autonomy debate. If individuals do what is in their own interests, isn’t it then moral to leave health care decisions fully up to them? It would seem that if one asked Thaler and Sunstein, the answer would be yes. However, although I am convinced of their argument for paternalism in public health, I believe libertarian paternalism can also be applied to treatment decisions in health care.
Individuals are—to an extent—capable of deciding what is best for them; but in the realm of health care, there is a lot of knowledge that professionals have access to that the average person does not. Even with thorough information—it is difficult for patients to make these sometimes life altering decisions. What is so wrong with a little libertarian paternalism? As Thaler and Sunstein mention in their essay, in everyday situations in which this type of paternalism is used, it is because the people do not want to undergo the hassle of making an initial decision themselves, or they feel as though they are not specialized enough in the matter to make the appropriate decision on their own.
Though I have never before viewed paternalism positively, I believe this essay makes a sound argument for it. This does not mean that paternalism is good; it just means that there are several situations in which it is conducive to efficiency and genuine well-being which should make it acceptable.
Thaler, Richard H., and Cass R. Sunstein. “Libertarian Paternalism.” Arguing About Bioethics (2003): loc. 10829-10968. Print.
As I read the piece by Trouer and Sunstein, I was also pleased about the way in which they turned the idea of paternalism into a good thing. Reading their piece made me think critically about the many important reasons as to why paternalism was beneficial. They were able to show and explain the flaws and misconceptions we can have as patients that can negatively affect our decision. I am not starting to feel a bit differently about paternalism.
I do disagree, however, where you say that doctors do not need to tell their patients everything. I think out of respect for the patient, the doctor should provide patients with everything they should know about a drug, procedure, etc. Whether it is by phone, by email, by conversation, or by providing the patient with medical handouts and brochures to read on their own time, I believe that letting patients know everything is imperative. It is this that can allow the patient to make moral and logical decisions, one of those decisions being to fully trust the physician and giving the physician the right to make the calls.
Issues with self control and inconsistently certainly give health care providers the idea that patients need more guidance and support than their autonomy entails. Patients tend to change their minds a great deal of time after hearing from family and friends and after having time for deep thought and contemplation. This causes the health care facility worry as the patient may be nearing a time when he/she may not longer have the power to decide what they do and do not want.
I agree with you where you said that paternalism is necessary in public health decisions. Many people may think for and of themselves rather than the well being of a large group of people and thus through paternalism, decisions can be made that will be relatively unbiased and able to benefit a large group.
I have a lot of thoughts pertaining to Trouer and Sunstein’s Paper on Libertarian Paternalism. I appreciate their alternative outlook on paternalism, viewing it not solely as an intrusive force of evil. Their definition of paternalism is slightly problematic for me because, as we talked about in class, it’s almost too inclusive. That doesn’t mean it’s wrong, it’s just difficult for me to think about paternalism in that way. But my personal preference for a definition doesn’t discredit theirs. However, in the way they define it, it makes me think about all the other “paternalistic” inclinations happen in our everyday lives. It automatically makes me think of education. If we think about how the whole class was pleasantly surprised at this new view of paternalism, why were we surprised? Because we had never heard it before? Not because it didn’t exist before, but because we hadn’t read anything with this view yet. Professors get to choose the things we read for class. In this sense, they make a very paternalistic decision in regards to our education, but even more so in regards to our opinions. We all quickly came to accept that paternalism, or at least strong paternalism was bad, but now after reading this article, we rethought that opinion. We expect to always be presented with both sides of a story, but we rely on other people to provide us with those things and it’s up to them to do so. Is this a paternalistic decision? According to Trouer and Sunstein, yes.
I’m not saying whether I agree or not yet, but it’s making me think about these other possible applications of paternalism.
I like your extrapolation of libertarian paternalism and its application to the patient-physician relationship. In may ways, I think it is already applied and practiced in the medical community When someone goes into a doctors office for let’s say a sinus infection and an antibiotic is prescribed, most people won’t ask the doctor to go through every single possible drug and its associated side effects. There are too many medications out there and there is not enough time to go through them all. Even if the doctor were to do so, how will the patient sift through every option to come up with the best one? They don’t. Instead, they rely on the doctor to make the choice for them based on their medical situation and allergies to certain medication. Even in a more complex treatment case, the possibility for the doctor to go through EVERY treatment option is highly improbable. Instead, the doctor paternally choses a few possible treatment options and describes those to the patient. Then the patient gets to decide which treatment process they would like to go through. Again, this “autonomous” decision made by the patient can be traced back to the earlier paternalistic decision made by the doctor.
I agree with you in the sense that people do not want to make decisions for themselves because they feel like they are not qualified enough to do so. Specifically speaking about public health, I think that there are many individuals who may think that they know what is best for them when, in reality, they do not. Health circumstances especially vary from person to person; what is good for one person may not necessarily be good for the other. Therefore, it is important that people do make their own decisions but they need some sort of background knowledge or guidance. This guidance should come from their physicians who should be used as a source when individuals are making their own decisions. It is important that we recognize the power of the individual’s own decisions, but it is also significant that we realize that people may not actually know what is best for them, and that we are prepared to help these people out by giving them direction towards the “right” decision for them. What is right for one person may not be right for another.
We have to recognized that there is a balance for paternalism in a doctor-patient relationship. Realistically, doctors tell different information to different kinds of patients. Say a doctor is treating an elderly person who has no way to access the internet to research a specific health topic. The doctor probably assumes a more paternalistic role in this situation. Certain patients can’t be expected to choose the best option and they trust their doctor to provide the best possible options. A doctor may know that a patient is a hypochondriac and probably shouldn’t be scared off by the mention of rare, but possible side effects. Realistically, can we say this level of paternalism is “bad” if it is in the best interest of the patient and both parties will be better off?
I found and article describing the trade-off between consumerism and paternalism: http://www.tandfonline.com/doi/abs/10.1207/s15327027hc0501_3#.UzYgd61dUvs. We think of doctors as healthcare providers, but we must remember they are also businessmen. In some cases, they are business owners. Exclusion of information can be detrimental to their practice, and and overly paternalistic role infuriates some patients. Doctors constantly think of “consumeristic accountability,” and they must respect the rights of the patients, which consumerism demands from the business side of healthcare.
I agree with parts of this argument, because the point of medical professionals is to help those less knowledgable on the matter. Physicians learn the proper way to treat a patient during medical school, so they really do know what they are talking about when they guide patients non-coercively. The only major part of your argument that I disagree with is that, “though the model of the doctor/patient relationship could use some serious work, patients do not need to know about each option available to them; being informed is important, but doctors are capable of narrowing down treatment options without full patient partnership.” While it is true that doctors are capable of narrowing down treatment options, it is seemingly dishonest to not confront the patients with all the possibilities. A physician can still guide a patient in the right direction without force, even if the patient is fully aware of all the options. Also, a lack of information given to the patient puts their autonomy in question. In summary, I think libertarian paternalism should definitely be used at times, however, only if the patient is fully informed about all the available possibilities. I also found a relevant video regarding shared decision-making, which incorporates patients choices and physician’s guidances. http://www.informedmedicaldecisions.org/what-is-shared-decision-making/
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