Medical paternalism is a set of attitudes and practices in medicine in which a physician determines that a patient's wishes or choices should not be honored.
These practices were current through the early to mid 20th century, and were characterised by a paternalistic attitude, surrogate decision-making and a lack of respect for patient autonomy.
[2] By the end of the 20th century and into the 21st, paternalistic medicine was increasingly seen as inappropriate in the West with guidance from professional bodies such as the General Medical Council indicating that it is ethically unsupportable.
[3] Traditionally, patients' roles were similar to that of a helpless, passive infant, while doctors held a dominant, parental position.
[5] In 1847, the American Medical Association's Code of Ethics stated: The obedience of a patient to the prescriptions of his physician should be prompt and implicit.
"[5] Physicians were encouraged to obfuscate test methods, medication names, and treatments, as well as withhold the abusive and addictive potential of medicines used at the time.
[7] In the 1950s, an article in the Journal of the American Medical Association covered whether or not a cancer patient (and/or their family) should be informed of the condition, in an attempt to limit potential distress.
If the patient was informed and experienced severe distress – "if they return to a pseudoinfantile state" – "they should be handled in many respects as children", potentially requiring a prefrontal lobotomy.
In 1956, Szasz and Hollender[9] introduced three models of paternalism to the medical community, thereby legitimising the view that doctors did not necessarily have to dominate patients.
Throughout history there have been many cases in which a patient is reported to have made a well-informed choice (while of sound mind) to opt for a medically improper treatment, or one that is very costly to their well-being.
[14] In many cases, particularly countries in which voluntary euthanasia is illegal, physicians must exercise medical paternalism by not respecting patients' wishes to die.