Paternalistic and non-paternalistic models
The first, basic, distinction between the types of doctor-patient relationship is the difference between paternalistic and non-paternalistic models. One reflects the traditional, centuries-old, type of relationship, another new one, which began to be formed only in the second half of the 20th century. The transition from paternalism to non-paternalism is a revolutionary change in the whole system of relations "doctor-patient."
Paternalism (from the Latin pater - father) is an ethical concept that treats the physician as the main figure in the relationship with the patient. The relationship between the doctor and the patient is unsymmetrical here. Like the parent-child relationship, the doctor in the paternalistic system establishes special guardianship relationships over the patient.
The patient acts as a non-independent figure, unable to make full decisions about his health and treatment. The doctor's task is to take care of the patient, protect him, make optimal decisions in his address. Just as parents are better than the child know what will be useful to him, and what is harmful, so the doctor in the paternalistic system considers himself free to act for the benefit of the patient.
Such a system of views is reflected in the ethical work of the school of Hippocrates.
There are also two versions of paternalism - strong and weak. Strong assumes the full dominance of the physician in the treatment process, while the patient does not participate in decision-making. The doctor acts at his own discretion for the benefit of the patient. "I will direct the sickness regime to their benefit in accordance with my powers and my intelligence," says the Hippocratic oath.
The concept of weak paternalism was proposed in 1971 by J. Feinberg. Weak paternalism takes place when the doctor makes decisions for the incompetent patient. Moreover, such a situation can often be temporary, then the doctor pursues the goal of bringing the patient back to the state of competence, so that the patient can further exercise his right to autonomy. Examples - mental pathology (reversible nature), temporary loss of consciousness, etc. In addition, weak paternalism means intervention without the patient's consent to determine its degree of competence. If it turns out that the patient is fully capable of making rational decisions, the physician proceeds to non-paternalistic relationships.
Paternalism has both positive and negative sides. He is attractive in that he gives the appearance of the doctor some parental traits. The patient, due to his situation of suffering, just needs such a caring attitude from the medical professional.
Negative features of paternalism: the patient's own will is not taken into account, the patient's complete dependence on the doctor (and the medical system as a whole), the patient's vulnerability to abuse by medical workers.
The modern ethics of medical care in developed countries is the ethics of the unconditional predominance of non-paternalistic relations . Accordingly, international ethical and legal standards support the concept of non-paternalism.
Nepaternalism - equality of the parties, partner interaction between the doctor and the patient in the medical process. The patient has the rights guaranteed by the law, first of all the right to autonomy (independent decision-making).
It is nepaternalism (to a much greater extent than paternalism) that leaves a doctor with an opportunity to show his best human qualities, but at the same time puts a barrier to the possible arbitrariness of doctors and strengthens the patient's position. A doctor in a non-paternalistic system of ethical-legal relationships can (and should) continue to take care of the patient, but at the same time must respect the patient, perceive him as a full-fledged personality, recognize him as the right to make his own decisions.
Of course, pure paternalism is an ideal. In practice, the doctor often has to perform certain paternalistic functions, acting for the benefit of the patient. Therefore, it is not at all that paternalism should be completely banished from modern medicine. On the contrary, the ethical task in practice is to achieve a reasonable combination of paternalistic and non-paternalistic elements in the interests of the patient, but the leading model remains nepaternalism.
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