Paternalism:The Conflict Between Autonomy And Beneficence In The Case Of The Temporarily Mentally Ill Patients

Abstract: The health care formulation of the principle of autonomy can be expressed as follows; ‘you shall not treat a patient without the informed consent of the patient, or his or her lawfulsurrogate, except in narrowly defined emergencies’. The principle of beneficence refers to a moral obligation to act for the benefit of others. In heath care, the good or benefit in question is the restoration of the health of the patient. In fulfilling this obligation of beneficence, the physician sometimes intentionally overrides the patient’s preferences or actions for the purpose of benefiting the patient. This is called paternalism. It therefore amounts to a violation of the principle of autonomy and hence there arises a tension or conflict between autonomy and beneficence. The principle of autonomy claims to be pre-eminent to the principle of beneficence and vice versa. Both have their arguments as well as their limitations. However, there is the need for at least weak paternalism for the mentally ill patients because of their diminished autonomy. But in the case of the temporarily mentally ill patient whose autonomy is both restored and diminished following the periodic and intermittent occurrence of his or her mental illness, there is a need to go deeper to find justification for paternalistic intervention. Both act and rule utilitarianism will find justification for paternalism in this case because the consequence of the action will be greater good for both the patient and the society. Kantianism will give it support from the point of view that the intention is to restore the autonomy of the patient by not using him or her as a means but as and end in himself or herself. Beauchamp and Childress will equally throw their weight behind the justification since prima facie obligations could be overridden in a conflict situation and since restricting a short term autonomy to protect and advance long term autonomy will appeal to common morality.