Growing Past Paternalism

After discussing Middlesex by Jeffrey Eugenides last Friday, I wanted to elaborate on our discussion about the Stephanides family’s interaction with the infamous Dr. Luce. This patient-doctor relationship consisted of Dr. Luce poking and prodding Callie and having her write her story in a journal. But it also existed in an asymmetrical balance of power, with Dr. Luce controlling all aspects of decision making regarding Callie’s case. This is a classic example of paternalism, a decision-making method that has significantly decreased in popularity over the last few decades. Paternalism “consists in acting in a way that is believed to protect or advance the interest of a person, even if acting in this way goes against the person’s own immediate desires or limits the person’s freedom of choice” (Munson, 103). This means that the individual doctor uses his own principles and values to make the decision that he thinks is best for his patient, a separate individual with a different set of beliefs. Although the doctor usually has good intentions when making this decision, it is unethical to deprive the patient of choice regarding his or her own health care. The problem lies in the imbalance of knowledge between the patient and the doctor, since the physician holds all the power, because he or she has the knowledge and skills learned in medical school. This asymmetry of knowledge leads to the patient’s dependence on the physician, and the nature of the relationship between the patient and doctor leads to the patient giving up some autonomy in the matter. However, paternalism takes this a step further when physicians withhold critical knowledge and make decisions for the patient that the doctor believes are in the best interest of the patient.

In Middlesex, Dr. Luce deprives Callie and her family of making a personal choice about what would be the best solution to her medical issue. And the problem with paternalism in this situation is clear. Dr. Luce withheld information from Callie that could have improved the working relationship between the two of them. Its very plausible that if Dr. Luce had been honest and straightforward with her, then Callie would have opened up and talked freely about the issues she lied about in her journal. In 20/20 hindsight, Dr. Luce could have explained Callie’s condition to her including her XY chromosomes, and Callie could have retracted her falsified journal and explained to Dr. Luce her feelings for the “Obscure Object.” Instead, paternalism damaged the patient-doctor relationship beyond repair, and you know how the rest of Cal’s story played out.

-Zac Ramsey

Munson, Ronald (2007). Intervention and Reflection. 8th ed. Belmont, CA: Thomson Higher Education, 2007.


~ by zacr12 on April 1, 2008.

One Response to “Growing Past Paternalism”

  1. Couldn’t agree with you more.

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