Moral Issue of PaternalismLouradel U. Alfonso, MAN, RN

Meng Tze/ Mencius

4 beginnings that differentiate man from beastFeeling of helpfulness and commiserationFeeling of shame and dislikeFeeling of modesty and yieldingSense of right and wrong

4 constant virtueshuman-heartednessRighteousnessProprietyWisdomAll men have a mind which cannot bear to see the suffering of others

PaternalismFrom the Latin wordPaternos-fatherActing like a father to a person for the latters own good and interestIntended to protect or advance the interest of its recipient, although such an act may go against the latters own immediate desires or may limit his freedom of choice.

TYPES OF PATERNALISM(WELFARE)PURE PATERNALISMIMPURE PATERNALISM(RECIPIENTS DEFECT AND SAFETY)RESTRICTEDEXTENDED(PROMOTION OF GOOD AND PREVENTION OF HARM)POSITIVE NEGATIVE(PATIENTS SENSE OF VALUES)SOFTHARD(RECIPIENT OF THE BENEFIT)DIRECTINDIRECT

PURE PATERNALISMJustifies the intervention into a persons life for the sole welfare of that personEx.Advising pregnant women to do prenatal check-ups

IMPURE PATERNALISMJustifies interference with another person not only for that persons welfare but also for the welfare of anotherEx.Parent of a JW should have a blood transfusion for the good of the patient and the family

RESTRICTEDSupports intervention which overrides an individuals action because of some defect or weakness in that individualExampleTelling the mother of the child with leukemia not to let his son play basketball

EXTENDEDIndividual is restrained from doing something because it is too riskyExampleNot allowing the 5 year old boy to ride on the horse by himself.

POSITIVE PATERNALISMPatient is forced into a rehabilitation program for his own goodExampleDrug addict forced into the mental asylum

NEGATIVE PATERNALISMPrevention of harmExampleCigars and alcoholic beverages are taken away from an addict

Soft paternalismPatients values are used to justify the intervention with his possible action or decisionExampleComatose pt, is detached from life-support machines because of her advance directives

Hard PaternalismPatientss values are not the ones used to justify a paternalistic actExampleDoctor decided to go on CS of a CPD case.

DIRECT PATERNALISMBenefit will be to the recipientExampleMotorcyclist obliged to wear helmet

INDIRECT PATERNALISMRestricts the activity of some individuals in order to prevent harm or to promote the good of others who cooperate with or participate in a harmful act.

Ex. Banning the production of marijuanaRestricts the liberty of one group to protect the others

Medical ContextPersonalTreatment of individuals in a fatherly way for their pown good.State paternalismimposing state laws upon the person most affected by the decisions to be made, without adequately heeding that persons own values or power to make decisions that directly affect them. These laws are made for the benefit and protection of the people.

JUSTIFICATIONS FOR PERSONAL PATERNALISMThe recipient of the paternalisic act is sick and consults the physician for medical adviceThe patient has some incapacity which prevents him from making decisionsNervous breakdown, minor, comatoseThe probable benefit of paternal intervention outweighs the probable risk of harm from non-interferenceDoctor has an obligation to act in the best interest of the patientThe patient upon consulting the physician, voluntarily transfers part of his autonomy to the doctor.

Jusfication of state paternalismImprove the quality of medical educationUpgrade a high standard of medical careTo control drug addicts, drug abuses, spread of AIDS and sex related diseases

APPLICATION OF ETHICAL THEORIESNatural lawEndorses paternalismKants ethicsAgainst paternalismStates that the person is a rational and autonomous being, self-regulating willwith exceptions, if the patient becomes unconscious then, the medical team should decide for the patient.

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