Medical Paternalism Research Articles

Artificial intelligence in healthcare: a scoping review of perceived threats to patient rights and safety

BackgroundThe global health system remains determined to leverage on every workable opportunity, including artificial intelligence (AI) to provide care that is consistent with patients’ needs. Unfortunately, while AI models generally return high accuracy within the trials in which they are trained, their ability to predict and recommend the best course of care for prospective patients is left to chance.PurposeThis review maps evidence between January 1, 2010 to December 31, 2023, on the perceived threats posed by the usage of AI tools in healthcare on patients’ rights and safety.MethodsWe deployed the guidelines of Tricco et al. to conduct a comprehensive search of current literature from Nature, PubMed, Scopus, ScienceDirect, Dimensions AI, Web of Science, Ebsco Host, ProQuest, JStore, Semantic Scholar, Taylor & Francis, Emeralds, World Health Organisation, and Google Scholar. In all, 80 peer reviewed articles qualified and were included in this study.ResultsWe report that there is a real chance of unpredictable errors, inadequate policy and regulatory regime in the use of AI technologies in healthcare. Moreover, medical paternalism, increased healthcare cost and disparities in insurance coverage, data security and privacy concerns, and bias and discriminatory services are imminent in the use of AI tools in healthcare.ConclusionsOur findings have some critical implications for achieving the Sustainable Development Goals (SDGs) 3.8, 11.7, and 16. We recommend that national governments should lead in the roll-out of AI tools in their healthcare systems. Also, other key actors in the healthcare industry should contribute to developing policies on the use of AI in healthcare systems.

Encountering the health and social environment after a pregnancy loss: A grounded theory study from male perspective

AimTo develop an empirical model that explores and explains the social process of the encounters of men who suffered pregnancy loss with health and social environments. MethodsA constructivist grounded theory method was performed, whereby 23 couples were interviewed using a semi-structured interview. Men that suffered pregnancy loss were analysed iteratively, with line-by-line and incident-to-incident coding, focused coding and axial coding, until data saturation and the emergence of theory. ResultsThe theory Behind bars that hide and mask them illustrates the social process of the encounters of men who suffered pregnancy loss with the health and social environment. Social taboo and gender stereotypes could repress, marginalize, and hide men's feelings. This transposed into the healthcare setting, which focused on the physical aspects of the woman, and lacked an emotional approach, follow-up, and sensitivity. Men reported a lack of recognition or family and social support. ConclusionMany men report not feeling involved in the care process after pregnancy loss, in addition to the prioritisation of medicalised care, which can be explained by a medical paternalism approach. These results provide a basis to reflect and plan the inclusion of men for the provision of comprehensive and couple-centred care. Implications for practiceCommunication strategies and emotional management, self-reflection of health professionals, theoretical-practical content with a gender perspective in the training of nurses and midwives, involvement of the organisation and leadership, and further research is required.

Bioethical, medical, and social problems in children with growth hormone deficiency

Background. Medical and practical advancements have brought about new possibilities for providing healthcare to people, but with it comes new bioethical challenges. In many pediatric medical institutions, consultations on pediatric ethics have become common practice. However, the bioethical problems related to short children have not been studied enough yet. The purpose of this study is to identify and analyze bioethical, medical, and social issues in children with growth hormone deficiency (GHD), which can potentially hinder timely diagnosis and adherence to replacement therapy. Materials and methods. The identification of bioethical, medical, and social problems was conducted at the Odesa Regional Children’s Hospital between 2012 and 2020. The study involved a cohort of 94 children with GHD and short stature (SDS 3.4 ± 0.1), aged 7.2 ± 0.4 years, as well as their parents (124 individuals). The study was based on a questionnaire survey, history taking, interviews, objective examination of patients, and analysis of medical records. Results. The study found evidence of violations of the Hippocratic principle of help and assistance (“do good”) in the form of delayed or incorrect diagnosis in 10.6 % of cases and incomplete adherence to local protocols for managing sick children in 6.4 % of cases. Violations of the Hippocratic principle of non-harm (“first, do no harm”) were evidenced by adverse events (16.0 %) and serious adverse events (3.2 %) during replacement therapy. Children with GHD were subject to violations of social justice, such as neglect (8.5 %), socio-economic problems in the family (12.8 %), and external environmental restrictions (9.6 %). Violations of the personal autonomy of children with GНD inclu­ded physical and psychological abuse in the family (29.8 and 38.3 % of cases, respectively), stigmatization (25.5 %), school bullying (27.2 %), medical neglect (5.3 %), medical paternalism (6.4 %), and overprotection (10.6 %). Conclusions. In the management of children with GHD, various bioethical, medical, and social issues have come to light. Low adherence to recombinant human growth hormone therapy can be considered an independent bioethical problem associated with medical paternalism and medical neglect.

Case Comment-JJ v Spectrum Community Health: When Medical Paternalism Meets Prisoners' Dignity.

Case Comment-JJ v Spectrum Community Health: When Medical Paternalism Meets Prisoners' Dignity.

Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

ObjectivesVarious treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of...

Hambatan dalam Menerapkan Perawatan yang Berpusat pada Keluarga di Lingkungan Pediatrik

This study aims to explore barriers to family-centered care (FCC) in the pediatric care area. The method used is a systematic review with literature searches from several online databases. The results showed that parents' perceived knowledge regarding FCC, namely the primary nurse-caregiver relationship, ward structure/policies, knowledge, ethical issues, limited health service resources, limited time in providing services, the nature of chronic disease, medical paternalism and professional mindset influenced FCC implementation. In conclusion, these findings provide strong evidence for understanding what is most important to nurses and the barriers to family-centered care (FCC) in the pediatric care area.
 
 Keywords: Barriers, Family-centered care, Pediatric

Women in Pain, Doctors in Power: Medical Paternalism in Suzanne E. Berger’s Horizontal Woman: The Story of a Body in Exile (1996) and Lynne Greenberg’s The Body Broken: A Memoir (2009)

Women in Pain, Doctors in Power: Medical Paternalism in Suzanne E. Berger’s Horizontal Woman: The Story of a Body in Exile (1996) and Lynne Greenberg’s The Body Broken: A Memoir (2009)

Reducing the risk of NHS disasters

How could we better use public inquiries to stem the recurrence of healthcare failures? The question seems ever relevant, prompted this time by the inquiry into how former nurse Letby...

The Influence of Medical and Socio-Economic Characteristics of the Population of Kazakhstan on the Frequency of Doctor Visits

Object: to find out how the frequency of visits to doctors in Kazakhstan is determined by the medical and socioeconomic characteristics of the population.Methods: a survey with 1,638 participants assessed annual doctor visit frequency using a seven-option question. For balanced data, responses were grouped into categories (first, second, seventh, and fifth and sixth combined). Additional questions captured socio-economic and medical metrics. Data collection and variable selection are detailed in the article, which employs a regression model for analysis. Findings: the authors touched upon the problem of low initiative of the population related to their health and “medical paternalism”, typical phenomena for most post-Soviet countries. As a result of the simulation, it was found that the results of the evaluation of the polynomial logit and the polynomial probit correspond to each other.Conclusions: the interpretation of the results in the polynomial model shows that any alternative is given in comparison with the base alternative, so increasing the independent variable makes the choice of the alternative more or less likely compared to the base alternative. So, the variables “Healthcare” and “Medical checkup” negatively affect the first category and positively affect the second, third and fourth categories.

A bit of medical paternalism? A qualitative study on power relations between women and healthcare providers when deciding on mode of birth in five public maternity wards of Argentina

BackgroundWhether women should be able to decide on mode of birth in healthcare settings has been a topic of debate in the last few decades. In the context of a marked increase in global caesarean section rates, a central dilemma is whether pregnant women should be able to request this procedure without medical indication. Since 2015, Law 25,929 of Humanised Birth is in place in Argentina. This study aims at understanding the power relations between healthcare providers, pregnant women, and labour companions regarding decision-making on mode of birth in this new legal context. To do so, central concepts of power theory are used.MethodsThis study uses a qualitative design. Twenty-six semi-structured interviews with healthcare providers were conducted in five maternity wards in different regions of Argentina. Participants were purposively selected using heterogeneity sampling and included obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. Reflexive thematic analysis was used to inductively develop themes and categories.ResultsThree themes were developed: (1) Healthcare providers reconceptualize decision-making processes of mode of birth to make women’s voices matter; (2) Healthcare providers feel powerless against women’s request to choose mode of birth; (3) Healthcare providers struggle to redirect women’s decision regarding mode of birth. An overarching theme was built to explain the power relations between healthcare providers, women and labour companions: Healthcare providers’ loss of beneficial power in decision-making on mode of birth.ConclusionsOur analysis highlights the complexity of the healthcare provider-woman interaction in a context in which women are, in practice, allowed to choose mode of birth. Even though healthcare providers claim to welcome women being an active part of the decision-making processes, they feel powerless when women make autonomous decisions regarding mode of birth. They perceive themselves to be losing beneficial power in the eyes of patients and consider fruitful communication on risks and benefits of each mode of birth to not always be possible. At the same time, providers perform an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place.

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

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.

“Home to Fail” Discharges: A Question of Motivation

Sending patients “home to fail” while anticipating their speedy readmittance is, prima facie, ethically troubling as are all unsafe discharges. However, “home to fail” cases may also be covertly ethically troubling insofar as they raise questions of medical paternalism due to a motivational component which drives these types of cases: by discharging a patient “home to fail” she will come to appreciate that living at home is unsafe and thus unwise, prompting her to choose differently in the future.

Doctors and Doctoring: An Analysis of the Cultural Discourses of Medicine


 
 
 
 The astonishing stories from the discourses of medicine portray the values of a doctor and the process of doctoring based on humanistic principles. Medical Humanities is an interdisciplinary field of study where one of the aims is to attempt to focus on the importance of empathy and kindness in medical practitioners who experience anguish, anxiety as well as professional satisfaction. Haris Qadeer introduces Medical Humanities, basically a Western thought, to the Indian context by compiling translated stories of illness and cure from the regional languages of India. The book, Medical Maladies: Stories of Disease and Cure from Indian Languages (2022), through nineteen fascinating short stories ranging from the early twentieth century to the contemporary period, discloses the various aspects of the cultural discourses of medicine in India. The translation of literary texts into other languages enhances their scope of obtaining a wider readership as well as reviews and critical analyses. A text like Medical Maladies opens the doors of regional Indian literatures so as to enable us to understand and study the vicissitudes of life portrayed in literatures in regional languages from all over the country. This paper attempts to analyse the impact of medical pluralism and medical paternalism on the treatment offered, changing medical gaze, the threats of the corporatization of medicine that makes doctoring a business, the influences of sociocultural beliefs in the suffering of women, and the challenges faced by the doctors, patients and other medical practitioners through a study of five stories from this collection. These include “Quarantine”, “A Day in the Labour Room”, “The Surgeon”, “Mantra”, and “Narova Kunjarova”
 
 
 

The 2023 Wakley Prize: spotlight themes in The Lancet's bicentenary year

What would Thomas Wakley, who founded The Lancet in 1823, make of medicine today? Progress over the past two centuries has been remarkable. Antiseptics and anaesthetics in surgery, life-saving devices and drugs, childhood and adult immunisation, the development of clinical trials, and digital health care are just a few of the advances that have improved patients’ lives. There has also been increased scrutiny of medical power, including medical paternalism, the colonial foundations of global health, the inequities of race-based medicine, and medical misogyny. Yet some principles have remained consistent despite the passage of time: trust between health-care professionals and patients, and the importance of respectful, compassionate care. In this 200th anniversary year of The Lancet, a journal that has reflected and shaped the changing medical landscape, we invite submissions for our annual essay competition, the Wakley Prize.

Who is sensitising whom? A participatory interview guide development as an awareness tool within a health care research project

Who is sensitising whom? A participatory interview guide development as an awareness tool within a health care research project

Two variants of 'constrained participation' in the care of vulnerable adults: A proof-of-concept study.

There has been a radical turn towards ideals of patient autonomy and person-centred care, and away from historically entrenched forms of medical paternalism, in the last 50years of nursing practice. However, along the way, some shades of grey between the areas of ideal patient participation and of outright patient non-participation have been missed. The current article constitutes an exploratory proof-of-concept study of the real-world traction of a distinction-straddling concept of 'constrained participation' and its two sub-concepts of 'fought-for participation' and 'forced-to participation'. In order to concretise these additions to the conceptual terrain of person-centred participation and its anti-theses, we apply them to themes in the care of vulnerable older adults. In the final section, we close by eliciting some characterological, educational and clinical implications of adding these new tools also to the conceptual repertoire of nursing practice and education.

Medical cannabis identity and public health paternalism

ObjectivesState-dependent and variable lists of medical conditions granting access to medical cannabis in the United States may be an example of public health paternalism. While purporting to ensure that medical use is clearly defined, the variability of approved conditions has created an atmosphere of ambiguity and medical precarity. The purpose of this study is to examine the relationship between “state” and “self” medical cannabis user identities and the ways non-medical users understand their cannabis consumption. Study designThis is a mixed methods study consisting of semi-structured interviews and survey data. MethodsIn Phase 1, we examined the relationship between self and state-sanctioned cannabis identity, drawing on the 2022 New Frontier Data Consumer Survey of current cannabis consumers (N = 4682). In Phase 2, we conducted eight semi-structured interviews with a separate sample of adults who use cannabis regularly but do not consider themselves “medical consumers”. ResultsSelf-reported cannabis identity was significantly related to the adoption of a cannabis consumer identity. Those who self-identified as solely medical or recreational consumers were more likely to reject the identity of “cannabis consumer” than those who identified as both. Self-medical identity was overshadowed by use for “wellness” among interviewees. Most interviewees, despite not identifying as medical users, report therapeutic benefit. Their identity as a cannabis consumer, is tied to the definition of “medical cannabis patient” where they live as well as the fluctuating role of cannabis related to their well-being across their lifespan. ConclusionsThe designation of medical vs. nonmedical use of cannabis varies from state to state, which is not the case for other medicine. This highly variable designation may be paternalistic in nature as governments attempt to differentiate between “legitimate” and “illegitimate” use in the context of federal cannabis prohibition. As a result, lines between medical use and wellness are blurred, which impacts consumer self-identity.

Right to Informed Consent, Right to a Doula: An Evidence-Based Solution to the Black Maternal Mortality Crisis in the United States

This Note seeks to build on existing research about how to improve childbirth in the United States for women, particularly for Black women, given the United States’ extremely high maternal mortality rate. Through examining the history and characteristics of American and Western childbirth, it seeks to explore how the current birth framework contributes to maternal mortality. To fight this ongoing harm, I suggest increasing access to doulas— nonmedical support workers who provide “continuous support” to the birthing person. Through this Note I seek to build on the research of others by identifying the ways medicalized birth practices fail women, particularly Black women, and possible solutions to this crisis. To that end, I examine the pathologization of childbirth, paternalism in medicine, and how the history of early gynecologists’ experimentation on enslaved Black women reverberates in the context of birth today, as both a cause of ongoing medical racism and paternalism, and as a symptom of misogyny, misogynoir, and racism. Furthermore, this Note builds on existing work in this field by suggesting a solution that has become more popular in recent years: the use of doulas to improve labor and childbirth. I identify why doulas are such an excellent tool to combat the current issues that plague women’s pregnancy and births in this country, specifically against a backdrop of how medical paternalism, racism, and the law have hamstrung women’s ability to safely birth. Finally, I suggest a workable solution to increase the usage of doulas by women who most need support: adding doulas to the “maternity and newborn care” essential health benefit, one of ten essential health benefits private insurers are required to cover under the ACA.

Decision-making at Life’s End: Sharing the Burden of Responsibility

This case study discusses the challenges of end-of-life decision-making in practice, focusing on the delicate balance between medical paternalism, shared decision-making, and the rights of surrogate decision makers. The family initially struggles to grasp the severity of their loved one’s medical condition but a pivotal moment during the Goals of Care meeting brings sudden clarity. This case explores the appropriateness and implications of the practice of informed non-dissent; and our analysis suggests that it is inappropriate unless there is compelling evidence for decision paralysis. Practical strategies are offered that facilitate compassionate dying care within the constraints of clinical urgency.

Spiritual Care.

The qualitative experience of sickness and death matters. Modern medicine has made important strides in addressing physical-and to some extent psychological-suffering at the end of life, but biomedical models are not properly equipped to respond to spiritual distress. Medical professionals and spiritual care professionals have an obligation, grounded in the bioethical principle of beneficence, to address all forms of suffering and to advocate for better dying. At the same time, they must approach care from a patient-centered standpoint that avoids spiritual or medical paternalism. The bond that clinicians and patients form through discussing and addressing spiritual distress allows patients to develop a clearer perspective of how their values can be best honored by the medical care team. Ultimately, modern individuals, caught between the dizzying array of possible life choices and the inevitability of mortality, experience immense spiritual need. The drive to care for these needs among dying individuals is a worthwhile pursuit, and traditional ideas of spirituality must expand to meet the needs of the modern individual.