Dr. Sandeep Jauhar, a cardiologist, offers anecdotal evidence in support of his argument that even though autonomy is, and should be, medicine’s guiding principle, paternalism has its place. The principle of autonomy in medicine encompasses a patient’s right to direct care his or her care, and requires the doctor to fully inform the patient regarding medical treatment. Dr. Jauhar reflects on his early belief that autonomy was “an absolute good, an ethical imperative that trumped all others.” After some years practicing medicine, his belief has changed.
Dr. Jauhar has come to believe that “no ethic in medicine is absolute.” Though the consequences of a breach of trust between a physician and a patient are severe, the consequences of full disclosure can be adversarial to the doctor’s duty to select the best course of treatment for his or her patients. However, Dr. Jauhar states that if a doctor believes that a paternalistic approach is necessary to a patient’s care, a soft approach is most appropriate. He describes hard paternalism as “coercive,” while soft paternalism “involves negotiation.”
Doctor’s groups, such as the American Medical Association, have urged the U.S. military to end the practice of force-feeding detainees in Guantanamo who have engaged in a hunger strike. Force-feeding requires that doctors and nurses strap the detainee to a chair, gag the detainee’s mouth, and then insert a nasogastric tube. The insertion of a nasogastric tube is uncomfortable in the extreme, even for a willing patient. Detainees resisting tube insertion may gag, have trouble breathing, or vomit. A motion filed in federal court to end the practice was rejected by U.S. District Judge Rosemary M. Collyer. Judge Collyer stated that the Court did not have jurisdiction, and if it did she would still reject the complaint. She claims that the “real complaint” is that the U.S. Government refuses to allow the detainees to starve themselves to death.