Masters Theses

Date of Award

12-1981

Degree Type

Thesis

Degree Name

Master of Arts

Major

Philosophy

Major Professor

Glenn Graber

Committee Members

Rem B. Edwards, Charles H. Reynolds

Abstract

This thesis deals with paternalism as an organizational institution in medicine. Institution is to be understood as a characteristic or persistent element of a culture that is widely sanctioned and which structures the interrelationships of different groups. To say that paternalism is an organizational institution is to limit the culture involved. The organization that shall be dealt with in this thesis is the organization of medicine.

It will be asserted that paternalism as an organizational institution structures the interrelationships of physicians and patients. It forces upon their interaction a specific nature, a particular power structure. It ensures that therapeutic decisions will be made in the context of a circumscribed value system. As paternalism is an institution of medicine, the nature and structure of the medical organization will shape the development of paternalism. Medicine is not only an organization, but is a profession. Consequently, the nature of paternalism will be strongly affected by the history and development of medical professionalization.

The definition of paternalism operant throughout this thesis is one developed by Allen Buchanan. It is,

... paternalism is interference with a person's freedom of action or freedom of information, or the deliberate dissemination of misinformation, where the alleged justification of interfering or misinforming is that it is for the good of the person interfered with or misinformed. (Buchanan, 1978; 372)

This definition will be used only in its application to paternalism as an organizational institution. It will only refer to interference with freedom of action or freedom of information as a characteristic style used by physicians in dealing with their patients, not as an occasional occurrence.

This thesis has two major tasks; to prove that paternalism is an organizational institution in medicine and to show why this is problematic ethically. The first task will be accomplished by means of an analysis of the history of paternalism in medicine and an examination of the way in which the structure of the organization of.medicine shapes paternalism as an institution. The second task will be dealt with by revealing paternalism as an organizational institution as a denial of the moral responsibility and autonomy of patients. Arguments for paternalism will be exposed as internally incoherent. Paternalism as an institution will be shown to be inconsistent with the goals which paternalism professes, the production and preservation of the benefit of patients.

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