Psychiatric paternalism between Scylla and Charybdis

Schöne-Seifert, Bettina
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
As much as strong medical paternalism should never be exercised, some weak paternalism towards patients is, on the contrary, part of physicians' and society's moral obligation. So far, this is a widely consented position in medical ethics. What then are the defining and the justifying conditions for legitimate weak paternalism in psychiatry? In this presentation it is argued in favor of three necessary and jointly sufficient conditions for ethically acceptable/ obligatory paternalism: (1) the patient must lack specific competency to evaluate his or her treatment options in a sufficiently autonomous way; (2) there must not be evidence that the patient had, in a former healthy state, been opposed to weak paternalism; (3) there must exist treatment options with a truly acceptable cost-benefit balance, that cannot be postponed until regain of competency, without harming the patient. Even if this seems a plausible normative frame, there remain difficulties in detail for both conceptual ethical theory and psychiatric practice. Among them are: assessing patient competency, avoiding undue control in patient preference formation, identifying third parties' interests, and evaluating treatment options. For psychiatry's self-understanding, societal image, and acceptance by patients and their families, it seems important to tackle these issues so as to get a coherent and transparent picture of the justification and limits of psychiatric paternalism.


Related Articles

  • Psychiatry is hard. Moorehead, Paul // CMAJ: Canadian Medical Association Journal;1/17/2006, Vol. 174 Issue 2, p210 

    The article presents the author's views on being a psychiatrist. He describes the condition of his patients. He expresses his difficulty of convincing his patients of anything. He relates a conversation he had with one of his patients. He points out that psychiatrists are not the only ones who...

  • Evaluating Patients for Impaired Medical Decisional Capacity: An Overview of Ethical and Clinical Issues. Rovner, Maxwell; Jackson, Willie Mae; Dinwiddie, Stephen H. // Psychiatric Annals;2015, Vol. 45 Issue 8, p417 

    An impaired ability to make treatment decisions is commonplace but often overlooked among medical and psychiatric patients. Evaluation of a patient's ability to meaningfully make treatment decisions is a complex exercise in clinical judgment, requiring careful attention to the effect of the...

  • Doctor–Patient Relations in Nazi Germany and the Fate of Psychiatric Patients. Hassenfeld, Irwin N. // Psychiatric Quarterly;Sep2002, Vol. 73 Issue 3, p183 

    German psychiatrists actively engaged in the forced sterilization and killing of psychiatrically disabled children and adult patients. Academic psychiatrists embraced the Nazi philosophy and led the way in the “final solution” for psychiatric patients. This took place in a climate of...

  • More Blues in ED?  // H&HN: Hospitals & Health Networks;Aug2000, Vol. 74 Issue 8, p24 

    Features a study on the number of children treated for psychiatric problems at the Yale University-affiliated Children's Hospital between 1995 and 1999. Implications of the findings; Results of the study; Most common diagnoses reported.

  • Randomised controlled trial of day patient versus inpatient psychiatric treatment. Creed, Francis; Black, Dawn; Anthony, Philip; Osborn, Madeline; Thomas, Philip; Tomenson, Barbara // BMJ: British Medical Journal (International Edition);4/21/90, Vol. 300 Issue 6731, p1033 

    Compares a randomised controlled trial of day patient and inpatient psychiatric treatment in Great Britain. Assessment on allocated patients; Contact with psychiatric services; Change in psychiatric symptoms.

  • The man who had 42 psychiatrists (and rising). Summerfield, Derek // BMJ: British Medical Journal (International Edition);04/28/2001, Vol. 322 Issue 7293, p1026 

    Presents the author's thoughts on a memorable patient he once had while on psychiatric training. Example of a patient who had been in clinical follow up for 20 years; Thoughts on the role of the institutionally minded field of psychiatry on the shape and substance of the patient's psychiatric...

  • Clinical responsibility: II Where does the patient stand? Clare, Anthony W. // British Medical Journal;12/24/1977, Vol. 2 Issue 6103, p1637 

    Analyzes the position of the patient in a psychiatric practice in Great Britain. Role of clinical psychologist as instructive example; Importance of the patient and therapist relationship to treatment; Need for skilled social workers in the management of patients.

  • Patients and family may be "easily mesmerized".  // Medical Ethics Advisor;8/1/2012, Vol. 28 Issue 8, p89 

    The article focuses on the ethical issues on the utilization of photo emission computed tomography (SPECT) scans for psychiatric patients.

  • Avoid getting caught between patient needs and economics. Simon, Robert I. // Psychotherapy Letter;Feb95, Vol. 7 Issue 2, p6 

    Focuses on the provision of quality health care to psychiatric patients regardless of costs. Possible confusion due to the emergence of health maintenance organizations (HMOs), independent practice associations (IPAs) and preferred provider organizations (PPOs); Consideration of plan...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics