Paternalism

Paternalism is closely related to the principles of nonmaleficence and beneficence and arises from the Hippocratic tradition of writings. The Hippocratic approach is interpreted as the clinician doing what he or she believes is best for the patient according to ability and judgment. This approach requires the dentist or hygienist to undertake a role similar to that of a parent, thus the term. Paternalism means the health care professional acts as a parent and makes decisions for the patient on the basis of what the professional believes is in the best interest of the patient. Paternalism should never be applied primarily to benefit the professional at the expense of the patient. Thus paternalism and autonomy may be seen as in conflict. A dentist or hygienist cannot unilaterally act on behalf of the patient without denying the patient’s right to exercise autonomy. Paternalism is now commonly called parentalism, reflecting and respecting the dual parent roles.

Patients today are well-informed about health, treatments, and their rights as patients and want to participate in the decision-making process. In the past, paternalism was a common practice partly because the health care provider had knowledge and skills and partly because patients expected the health care provider to make decisions in their best interests. Patients often had no knowledge that alternative care options were available. Furthermore, even if patients did know other options existed, many placed the professional in a parental role by asking the professional what they should do. Patients frequently had so much trust in the provider that they would do whatever was suggested. Such paternalistic acts were carried out with good intentions to benefit the patient and often became second nature to the clinician. The responsibility of the dentist and dental hygienist is to educate the patient about the balance of benefits and risks of treatment, which often creates a conflict between autonomy and beneficence. This aspect of providing ethical care is most important and requires the clinician to take the time and effort to ensure the patient has all the knowledge required to make health decisions. Many dentists have been asked by a patient–and have refused–to remove a healthy dentition merely because the patient believes that taking care of dentures would be easier than caring for their natural teeth.