Case One: Patient Interests and Medical Paternalism (Focus: Bioethics)

Case One: Patient Interests and Medical Paternalism (Focus: Bioethics)

The most fundamental question presented by this case is, “Who is in position to judge what is in the patient’s best interest?” To many, the answer seems clear. Respect for the autonomy of the patient requires that he have the power to make decisions regarding his medical treatment. That is, there is a presumptive case in favor of allowing patients the right to determine for themselves the course their lives will take, and this includes the course their medical treatment or non-treatment will take. This rests on the assumption that patients are capable of exercising autonomy. But, what is required for a person to be in a position to exercise genuine autonomy? In order to make autonomous decisions two conditions must be satisfied. First, the agent must be minimally rationally capable. In other words, a patient must be capable of recognizing and weighing differences between diverse treatment options, and then be able to reach a reasoned conclusion. In this case, the issue is complicated by the fact that the patient is a minor. Nevertheless, that we have chosen the age of 18 to be the ‘age of reason’ seems arbitrary, and certainly there is a case to be made that many persons under the age of 18 meet the condition of minimal rationality. The second condition for autonomous action is that the individual must have knowledge relevant to making informed decisions. Though one may have the rational abilities to make decisions with respect to investing money in the stock market, he might lack the knowledge to make informed choices. Hence, he should rely on others with knowledge to make decisions on his behalf. Likewise, we may wonder whether patients can make informed choices regarding their medical care.

Case One: Patient Interests and Medical Paternalism (Focus: Bioethics)



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