Skip to main content
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 1995 Dec;21(6):327–331. doi: 10.1136/jme.21.6.327

Rational non-interventional paternalism: why doctors ought to make judgments of what is best for their patients.

J Savulescu 1
PMCID: PMC1376828  PMID: 8778455

Abstract

This paper argues that doctors ought to make all things considered value judgments about what is best for their patients. It illustrates some of the shortcomings of the model of doctor as 'fact-provider'. The 'fact-provider' model fails to take account of the fact that practising medicine necessarily involves making value judgments; that medical practice is a moral practice and requires that doctors reflect on what ought to be done, and that patients can make choices which fail to express their autonomy and which are based on mistaken judgments of value. If doctors are properly to respect patient autonomy and to function as moral agents, they must make evaluations of what their patients ought to do, all things considered. This paper argues for 'rational, non-interventional paternalism'. This is a practice in which doctors form conceptions of what is best for their patients and argue rationally with them. It differs from old-style paternalism in that it is not committed to doing what is best.

Full text

PDF
327

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brock D. W., Wartman S. A. When competent patients make irrational choices. N Engl J Med. 1990 May 31;322(22):1595–1599. doi: 10.1056/NEJM199005313222209. [DOI] [PubMed] [Google Scholar]
  2. Hope T., Sprigings D., Crisp R. "Not clinically indicated": patients' interests or resource allocation? BMJ. 1993 Feb 6;306(6874):379–381. doi: 10.1136/bmj.306.6874.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. McNeil B. J., Pauker S. G., Sox H. C., Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982 May 27;306(21):1259–1262. doi: 10.1056/NEJM198205273062103. [DOI] [PubMed] [Google Scholar]
  4. Savulescu Julian. Rational desires and the limitation of life-sustaining treatment. Bioethics. 1994 Jul;8(3):191–222. doi: 10.1111/j.1467-8519.1994.tb00255.x. [DOI] [PubMed] [Google Scholar]
  5. Tversky A., Kahneman D. The framing of decisions and the psychology of choice. Science. 1981 Jan 30;211(4481):453–458. doi: 10.1126/science.7455683. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES