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Physicians and Paternalism

The physician-patient relationship is a paternalistic, beneficent relationship; that is, the physician is expected to do what is medically best for the patient. Paternalism and beneficence are important in the physician-patient relationship because of the physician's superior technical knowledge and access to pharmaceuticals and medical technology. Despite the importance of patient involvement and informed consent, physicians are expected to do what is best for their patients. Even the termination of life-support cases are predicated on the assumption that termination is in the patient's best interest. (See Chapter 13.)

The courts' skepticism in cases in which patients allegedly make an informed choice of medically improper treatment highlights the expectation that physicians will offer patients only the choice of medically proper and indicated treatments. (See Chapters 9 and 11.) This reflects a general societal consensus on what constitutes acceptable medical care. In most cases, physicians, patients, and society agree on the desired outcome and the appropriate spectrum of treatments to accomplish that outcome. While this is not meant to minimize the very real conflicts between physicians and patients, debates over contentious issues such as abortion, right to die, and entrepreneurial medical practice tend to obscure the congruence of interest that defines the vast majority of patient care.

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