4. (a) Citing the serious adverse effects of long-term medication, a doctor convinces the family of a female patient for surgery. This led the patient to reluctantly consent for the surgery, though her original choice was to opt for medication. Explain the concepts of paternalism and beneficence by analysing the doctor’s action. (Answer in 150 words)
Introduction
The case presents a conflict between beneficence—the doctor’s duty to promote the patient’s welfare—and autonomy—the patient’s right to decide what happens to her own body. The doctor may have had genuine concern for her health, but the manner in which the decision was influenced raises ethical concerns.
Beneficence
- Patient welfare: The doctor appears to have recommended surgery because she believed it would provide better long-term health outcomes.
- Professional responsibility: A doctor has a duty to explain the benefits, risks and alternatives of available treatments.
- Prevention of harm: Explaining the serious adverse effects of prolonged medication reflects the principle of non-maleficence.
- Informed choice: Honest and understandable medical advice can help the patient make a decision based on facts rather than fear.
- Good intention: There is no indication that the doctor acted for personal benefit; her primary concern appears to have been the patient’s health.
Paternalism
- Substituting professional judgement: The doctor’s preferred treatment appears to have been given greater weight than the patient’s original choice.
- Family influence: Convincing the family instead of adequately counselling the patient herself weakens her independent decision-making.
- Reluctant consent: If the patient’s consent resulted mainly from family pressure, its voluntariness becomes questionable.
- Respect for autonomy: A competent adult has the right to accept or refuse treatment after receiving adequate information.
- Ethical boundary: The principle of informed consent, reinforced in Samira Kohli v. Dr. Prabha Manchanda, requires respect for the patient’s autonomous choice except in recognised exceptional circumstances.
Example: If a competent patient understands that a medicine has long-term risks but still prefers medication after discussing alternatives with the doctor, the doctor may recommend surgery strongly but should not use the family to pressure her into accepting it.
Conclusion
The doctor’s intention may be beneficent, but her approach becomes paternalistic when it undermines the patient’s independent choice. Ethical medical practice requires doctors to inform, advise and persuade through reason, while ultimately respecting a competent patient’s informed decision.
Ravi Raaz
Hassan Khan
Shadab Ali