Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway.
Bioethics. 2024 Jul;38(6):539-548. doi: 10.1111/bioe.13307. Epub 2024 May 21.
The present study aims to explore the forms paternalistic communication can take in doctor-patient interactions and how they should be considered from a normative perspective. In contemporary philosophical debate, the problem with paternalism is often perceived as either undermining autonomy (the autonomy problem) or the paternalist viewing their judgment as superior (the superiority problem). In either case, paternalism is problematized mainly in a general, theoretical sense. In contrast, this paper investigates specific doctor-patient encounters, revealing distinct types of paternalistic communication. For this study, I reviewed videorecorded encounters from a Norwegian hospital to detect paternalism-specifically, doctors overriding patients' expressed preferences, presumably to benefit or protect the patients. I identified variations in paternalistic communication styles-termed paternalist modes-which I categorized into four types: the fighter, the advocate, the sympathizer, and the fisher. Drawing on these findings, I aim to nuance the debate on paternalism. Specifically, I argue that each paternalist mode carries its own normative implications and that the autonomy and the superiority problems manifest differently across the modes. Furthermore, by illustrating paternalism in communication through real-life cases, I aim to reach a more comprehensive understanding of what we mean by paternalistic doctors.
本研究旨在探讨家长式沟通在医患互动中可能采取的形式，以及从规范的角度应如何看待这些形式。在当代哲学论争中，家长主义的问题往往被视为要么破坏自主性（自主性问题），要么家长主义者认为自己的判断更优越（优越性问题）。在这两种情况下，家长主义主要是在一般的、理论的意义上被视为有问题的。相比之下，本文调查了具体的医患接触，揭示了家长式沟通的不同类型。在这项研究中，我回顾了挪威一家医院的录像记录，以发现具体的家长式做法——医生无视患者表达的偏好，这可能是为了使患者受益或保护他们。我发现了家长式沟通风格的变化——我称之为家长式模式——并将其分为四种类型：斗士、倡导者、同情者和渔夫。基于这些发现，我旨在使家长主义的辩论更加细致入微。具体来说，我认为每种家长式模式都有其自身的规范含义，而且自主性和优越性问题在不同模式下表现不同。此外，通过真实案例展示沟通中的家长式做法，我旨在更全面地理解我们所说的家长式医生的含义。
