Relational autonomy and paternalism – why the physician-patient relationship matters

Abstract

Both paternalism and relational autonomy are two concepts that are much discussed in medical ethics. Strangely enough, they have hardly been considered together. How does the understanding and justification of medical paternalism change if we take a (constitutively) relational understanding of autonomy as a basis? From an individualistic understanding of autonomy, medical paternalism interferes in the individual sphere of a patient. It can be justified if the benefit to the patient clearly outweighs the extent of the violation of their autonomy. I argue that according to a relational understanding of autonomy other justification criteria come to the fore than those we know from the ‘classic paternalism debate’. Building on the concept of maternalism introduced by Laura Specker-Sullivan and Fay Niker, I propose that the nature and quality of the physician-patient relationship, the epistemic access to the patient’s pro-attitudes, the physician’s motivation to intervene, and intersubjective recognition constitute relevant justification criteria. In addition, I argue that these criteria provide helpful indications of how physician-patient relationships should be structured in order to enable relational autonomy in patient care and avoid medical paternalism in general.