Abstract
BackgroundWe aim to further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision-competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by questioning the patient’s decision-making competence.MethodsA previously presented index, based on a cross-sectional study, was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole sample. We recalculated the results from a 2007 study for comparison to a new study conducted in 2020. Both studies are about physicians’ attitudes towards, and arguments for or against, physician-assisted suicide.ResultsThe 2020 study showed that geriatricians, palliativists, and middle-aged physicians (46–60 years old) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs and surgeons) had indices indicating high degrees of disguised paternalism.ConclusionsThe proposed index for identifying disguised paternalism reflects the attitude of a group towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice. Methods for improving measures of disguised paternalism are worthy of further development.
Highlights
We aim to further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision-competent at the end of life
In order to better understand the suggested and updated indices of the six specialties, we have provided their attitudes towards physician assisted suicide (PAS) in terms of those who supported PAS (Table 3)
A comparison of the 2007 results to the 2020 results focusing on how important the participants found the four provided arguments to be, there was only one argument—the open paternalistic argument that such patients do not know their own best interests—with a significant difference; in 2007 it was 74% compared with 59% in 2020 (Table 1)
Summary
We aim to further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision-competent at the end of life. For example, a physician finds that a patient does not understand her or his own best interests—e.g. the beneficial consequences of an offered treatment that the patient declines—and makes the decisions on behalf of the patient [1, 2]. If such a patient is competent, the action is referred to as hard paternalism. Patient autonomy means that there is no reason for a physician to make decisions about what is in a competent patient’s best interest [4]. There might, be circumstances where hard paternalism is justified, e.g. in cases where the patient is declining life-saving treatment due to unbearable pain [6]
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