The justification of medical paternalism.

This paper examines the moral justification of medical paternalism. It is shown that while there are sufficient grounds to justify the practice of medical paternalism in some instances, there are many instances of the practice which cannot be justified. The application of the utilization principle of paternalism is considered in detail. It is argued that the physician can justifiably apply the principle in a particular case only after he has determined both that there are no alternate non-paternalistic courses of action which will have the same results and that he is in the same privileged position with respect to any relevant non-medical considerations as he is in with respect to medical considerations. The moral constraints on paternalistic action flowing from the concept of personal autonomy are also examined. It is concluded that medical paternalism is justified only when utilitarian considerations apply and when they do not violate personal rights. This occurs only when the subject of paternalism is not fully competent, when he has explicitly or by implication given consent, or when it can be reasonably concluded, from the knowledge of his emotional and cognitive make up, that he would approve of such treatment. For the most part, only the physician with a more intimate knowledge of his patient than is possible in most modern medical practice is in the position to undertake medical paternalism with moral propriety.