David Buchanan's Autonomy, Paternism Vs. Paternalism In Public Health

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Within public health, the issue of paternalism has become a controversial topic. Questions about the ethics of public health are being asked. The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied context (Med J Aust. 1994). Clinically, patients are treated on a one on one basis, but public health’s obligation is toward the protection and promotion of an entire population’s health. So, based on this difference, the gaping questions targeting public health now becomes, under what conditions is it right to intervene and override an individuals’ autonomy? And if so, is the paternalistic intervention justified? Part of the concern…show more content…
Rather, Buchanan proposed the field of public health to gain the public’s trust, needs to expand individual autonomy by promoting social justice while discussing the common portrayals of justice. The rationale behind Buchanan’s work is to bring understanding to an ethical issue of paternalism v. autonomy in public health. Paternalism can be justified given it protects the interest of the people and autonomy is an individual’s freedom from external control or influence. There are valid arguments for both sides, but in public health, paternalism is very useful situationally, while autonomy must be preserved and respected as it is an individual given right. Aiming for an ideal range where public health policy and individual freedom can overlap, no matter the inconsistencies, is the…show more content…
The patient should have confident and trust in their doctor, but the doctor must also recognize that the patient is entitled to have an attitude to illness and his preferred way of tackling this (Turner-Warwick, 1994). Buchanan infers that paternalism eliminates an individual’s power of making their own choices and thus pressed into making decisions. To achieve public health goals, greater considerations must be directed toward promoting a mutual understanding of a just society (Buchanan, 2008). So, if people are given the choice to make certain decision over another, then they are still granted freedom of choice. Buchanan identifies 3 arguments in justifying paternalistic actions: informed consent, weak paternalism, and utilitarianism. To support his argument of informed consent, Buchanan admits there is no significant ethical concern because an individual may reach out to the professional for help, but it is problematic when an intervention is targeting the entire population (Buchanan, 2008). This point of view from Buchanan is flawed and completely limits what public health is all about. The Institute of Medicine (IOM) defines public health as “what we, as a society, do collectively to assure the conditions for people to be healthy.” With its use of the phrase “we, as a society,” the IOM emphasizes cooperative and mutually shared obligation and it also reinforces the notion that collective
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