Medical Paternalism in Clinical Genetics
Prior to the late 1970s, medical paternalism was the dominant model of the health professional – patient relationship. The strongest argument against medical paternalism relates to the universally recognised bioethical principle of autonomy. To guard against paternalistic counselling, we provide ample opportunity for clinical discussions that are aimed at empowering the patient / client to make personally meaningful decisions. These sessions are always, particularly in a stretched public health system, relatively time-consuming (therefore economically taxing) and sometimes patience-testing, but this standard is currently embraced as ‘best practice’ in clinical genetics. However, as genetic medicine becomes increasingly complex and technologically based, could we, as knowledgeable, experienced genetic professionals, be tempted to revert to the practice of medical paternalism in a well-meaning effort to reduce the burden of patient / client responsibility to understand, process and decide between all available courses of action relating to revelation of personal and family genetic information? Could we also invoke the Utilitarian principle of ‘greatest good for the greatest number’ to justify an improvement in equity of access to genetic services potentially made possible by reducing clinical time devoted to such empowering discussions? Are we already doing this? Some would also argue that the very manner in which healthcare professionals offer screening and genetic testing options as ‘routine’, in effect, generates a paternalistic message that uptake of such tests is considered to be socially responsible behaviour. These professionally challenging ethical issues will be examined and discussed from a philosophical viewpoint.