Although there may be disagreement on how to define the term "paternalism", there seems to be an origin of paternalism, other than that from the physician, which can affect the degree of autonomy which a patient can express. In my view, paternalism is a parental form of direction or order to the patient to the effect "we know what is best, you may not understand it but follow what we say." This kind I think originates from institutions within our social or political environment.
Here are some examples that come to mind. In many states there is prohibition of a pregnant woman from writing an advance directive or expressing a directive to terminate her life support. There are social pressures interfering with legal abortion, insurance companies and HMOs withholding of medically appropriate diagnostic or therapy procedures, arbitrary inequality of pay for women for similar work by men and social stigma which prevent blacks from receiving the same quality of medical care as non-blacks for certain conditions. In addition, there is the pressures from pharmaceutical companies through their direct to consumer advertising of incomplete and misleading information about their products. How about the "media" setting standards for how men and women should behave and appear. The flood of ads for anti-erectile dysfunction drugs may lead normal healthy men to question their own sexual powers and ask their doctor for a prescription. And social pressures by the media on women describing what is considered beautiful or sexy encourage requesting non-restorative cosmetic surgery.
Some may say that this is not paternalism at all but only social norms or attempts at patient education. On the other hand could many of these actions represent some form of coersion which in essence tends to deprive the patient from making medical decisions about their treatment without undue influence? It would be of interest to read what my visitors would say about this subject. ..Maurice.
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