lect 4, 5 Paternalism.docx

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Physician Paternalism  Differences in opinions of physician and patient cause problems  Who should decide what treatment the patient gets? Physician, patient, or patient’s guardians (in the case where patient is non-autonomous)?  Weak paternalism – directed at someone who is either temporarily or permanently non-autonomous  Strong paternalism – directed at someone who is fully autonomous  very controversial: acceptable or not?  Violates autonomy Justifying Strong Paternalism Different views 1. on grounds of beneficence: benefits of future wellbeing outweigh cost of autonomy 2. on grounds of autonomy: interfering with patient’s autonomy now will greatly enhance their later autonomy (ex: in a case of suicide, others prevent so that they can have autonomy later)  Kantian view – one supreme principle (autonomy), therefore paternalism is hardly ever, or even never justified  Utilitarians – to maximize benefit over cost, then paternalism will be justified John Stuart Mills  Utilitarian 5 premises 1. Restraint is an evil 2. Can’t appeal to the interest of others, so need sufficient justification t 3. Consideration of individual’s own interest  You care a lot more than your wellbeing than I do, if I think I know better, it must be based on generalizations of nature, but sometimes generalizations can be false or misapplied in a certain case  Premise 4 relies heavily on individuals know what is best for them: but it’s questionable how far this goes  Paternalism is usually unjustified  Problem with slavery is that the slaves have denied autonomy Dworkin  Thesis is that paternalism is sometimes justified  Pure paternalism – person whose liberty is being restricted is the same person who benefits from it  Impure paternalism – person whose liberty is being restricted is not the same as the person who benefits from it  preventing harm in others is sometimes sufficient justification for the use of force; no other reasons will be good enough to justify the use of force  Rule out use of force for paternalistic and moralistic (laws that are intended to enhance moral rightness) reasons  Ex: Not justified using force to prevent man marrying a dog  To premise 2, autonomy is intrinsically valuable, therefore intrinsically troubling if being interfered. Autonomy – full free standing member of society, should have ability to make own decisions, if interfered, individual is denied of status in society  In favor of liberty  Mills exception: selling one into slavery  shouldn’t be enforced because once sold into slavery, there will be no more liberty  Problem with slavery is that the slaves have denied autonomy  Does not like the idea that paternalism is justified based on future consent (ex: towards children), because it almost justifies too much, could be potentially dangerous  Difference between evaluative judgements and empirical /descriptive judgement: someone who is not wearing a seatbelt because does not know the risk/someone who wants to wear seatbelt (cognitive mistakes) but forgets vs. someone who is not weighing risk correctly so not wearing it (different value)  disagreement about values  Hard cases of medical paternalism is not because one
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