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Paternalism Has Its Place

May 16, 2014

I’d like to talk a little today about Paternalism.  The root of the word is Pater, which means father.  So the meaning of paternalism is, essentially, father-ism. Not everyone has an awesome dad like I do, but even if you don’t, everybody has a general ideal in their heads of what a father is supposed to do.  It’s a little old-fashioned, but we expect fathers to take care of us, provide for us, keep us safe, and teach us how to be good adults, right?  A father’s job is generally try to make the best decisions he can for you based on what he knows about you when you can’t make these decisions for yourself.  And after you become independent, he’s supposed to have good advice based on his training in life and his knowledge of you.  So I kind of have to ask – what’s wrong with paternalism?

My father recently pointed out a piece that NPR did on medical ethics, in which Terry Gross interviewed NYU medical ethicist and internist Dr. Barron Lerner.  Dr. Lerner had a father ( Meyer Lerner) who was also a doctor, and thus has both his own modern take on bioethics as well as his father’s very different perspective from the generation before.  In his book, “The Good Doctor”, Lerner tells a bunch of stories about instances in which his father made a decision or performed an action that today would be considered unethical.  For instance, in one case Meyer Lerner literally throws his body across that of an elderly patient that his colleagues were about to perform CPR on, because he felt it was futile and cruel.  In another, he withholds the fact of a terminal diagnosis from a patient.  He also took care of family members, which today is generally felt to be a bad idea.

In all honesty, in all of these stories I would rather have had the father as a doctor than the son.  I truly hope that someone throws themselves across my body when I’m old and my heart stops.  I’d probably like to know if I was dying, but not everyone does.  My grandfather took care of my dad, and me, actually, a few times and I felt it was wonderful to be taken care of by my grandfather, who not only was a doctor, but loved me.  But here’s the key reason why I would gladly have had Meyer Lerner as my doctor (I’m sure Barron is a wonderful doctor, BTW): he knew his patients incredibly well.  He was intensely involved with the patients, their families, and their lives.  Patients loved him, nurses loved him, he was highly esteemed in the hospital where he had admitted for many years.

Meyer Lerner was paternalistic, no question.  Was that a bad thing?  Did he make bad decisions?  Did his patients feel railroaded or ordered about?  Was he making decisions in his own self-interest?  I have to say in general, no.  The rejection of paternalism in present-day ethics has been, to some extent, forced upon doctors by a nation of patients who have lost our trust.  Meyer Lerner treated his patients well because he knew them and they trusted him because he took the time to get to know them and to do what he was trained to do.  He had relationships with his patients. He knew what was important to them.  He was committed to them.  That sounds like my dad.  I’ll take that kind of father-ism any day.



From → Healthcare

  1. thetinfoilhatsociety permalink

    I totally agree. As a future NP, I have had this very discussion with friends — how can I possibly give you the best advice and/or education if I don’t know you and your specific circumstances? If we really want patient centered care, we have to know our patients as more than just charts and faces.

  2. Sherie, as a colleague anesthesiologist myself, I read your your column faithfully. It therefore pains me to have to put on my pedant’s cap and point out that the “it’s” in your title shouldn’t have an apostrophe. This one error seems to trip up a lot of otherwise accomplished writers.

    Pronouns don’t require apostrophes to form possessives like nouns do. They only need apostrophes to form contractions. So if you’re tempted to add an apostrophe as in your title, substitute “it is” for “it’s” and see if it sounds right.

    And I’m with you; I want someone to break the gastroenterologist’s arm when she tries to put in a PEG tube because my demented husk of a self has obeyed nature’s merciful suggestion to stop eating.

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