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Paternalism v. autonomy

Published online by Cambridge University Press:  02 January 2018

Paul Crichton*
Affiliation:
Ministry of Justice. Email: paulcrichton@doctors.org.uk
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Abstract

Type
Columms
Copyright
Copyright © The Royal College of Psychiatrists 2017 

Lepping et al Reference Lepping, Palmstierna and Raveesh1 rightly point out that autonomy is only one of several important ethical values, which, in the patient–doctor relationship, needs to be weighed against other values such as beneficence and justice. However, they do not seem to be aware of the factors which reduce our autonomy and how limited it therefore is in the first place. These factors include manipulation (think of the Brexit campaign), oppressive socialisation, coercion (e.g. through legislation), overconformity (which in the medical context may mean uncritical acceptance by patients of the suggestions of paternalistic doctors), inner necessity (the strong feeling that we have to do what we want to do – Martin Luther's ‘Here I stand. I can do no other’) and luck (we often think we are responsible for outcomes which are simply lucky occurrences). Reference Kahneman2,Reference Crichton3 As a consequence, our autonomy is much more limited than we think it is. For this reason, we need to consider how best to increase our autonomy, and the autonomy of patients, so that it can at least compete with other important values.

References

1 Lepping, P, Palmstierna, T, Raveesh, BN. Paternalism v. autonomy – are we barking up the wrong tree? Br J Psychiatry 2016; 209: 95–6.Google Scholar
2 Kahneman, D. Thinking, Fast and Slow. Penguin, 2011.Google Scholar
3 Crichton, P. Self-Realization and Inner Necessity. Kiener Press, 2013.Google Scholar
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