How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making

AJOB Empir Bioeth. 2018 Apr-Jun;9(2):91-98. doi: 10.1080/23294515.2018.1462273. Epub 2018 May 3.

Abstract

We conducted an empirical study to explore clinician and lay opinions on the acceptability of physician paternalism. Respondents read a vignette describing a patient with brain hemorrhage facing urgent surgery that would be lifesaving but would result in long-term severe disability. Cases were randomized to show either low or high surrogate distress and certain or uncertain prognosis, with respondents rating the acceptability of not offering brain surgery. Clinicians (N = 169) were more likely than nonclinicians (N = 649) to find the doctor withholding surgery acceptable (30.2% vs. 11.4%, p ≤ 0.001). Among clinicians, the doctor withholding surgery was more acceptable when prognosis was certain to be poor (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.04, 4.01). There was no effect of surrogate distress on clinician ratings. Responses among lay public were more variable. Given the differences in attitudes across clinicians and lay public, there is an ongoing need to engage stakeholders in the process of end-of-life decision making.

Keywords: brain injury; decision making; end-of-life issues; medicine; professional–patient relationship.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel
  • Clinical Decision-Making / ethics*
  • Critical Care / ethics*
  • Critical Care / psychology
  • Female
  • Health Services Research
  • Humans
  • Life Support Care / ethics*
  • Male
  • Middle Aged
  • Paternalism* / ethics
  • Physician-Patient Relations
  • Physicians / ethics*
  • Physicians / psychology
  • Prognosis
  • Third-Party Consent / ethics
  • United States
  • Withholding Treatment
  • Young Adult