Paternalism And The Right To Withhold Information

This essay will establish Dworkin, Goldman and Ackerman’s viewpoints on the subject of paternalism, and directly relate them to a case involving the withholding of substantial information from a person. This case revolves around the concept of withholding significant information, specifically the death of a young child, from the mother of that child. Reading Dworkin’s article one can understand his view that under certain conditions it will be permissible for an authority to act paternally towards another person or group. Goldman would reject this claim and say that it is a fundamental right for an individual to be able to control one’s own life (p. 109), essentially rejecting paternalism and the right of the doctors to withhold this information from the mother. Finally, Ackerman will claim in support of paternalism, that it is difficult to respect personal autonomy due to the transforming effect of illness and potential life and death scenarios (p. 110).

I truly believe that one’s ability to self-govern and self-determine is a crucial and vital part of our freedoms as a society, however I do also acknowledge the potential for life threatening situations to alter a person’s rational ability to self-govern. This means that I do agree with Goldman to a certain extent that people should have the right to self-determine, however I also agree with Ackerman that illnesses have the potential to alter one’s own ability to exercise rational autonomy. So where I fall is somewhere in the middle with Dworkin, I do not reject the doctor’s ability to withhold certain information as long as it will help enable a person’s ability to rationally decide or act in accordance with their own autonomy. Dworkin argues that there is a possibility in certain scenarios, mainly ones that will preserve or enhance one's rational autonomy, that paternalism is in fact a justified practice. Dworkin states, “I suggest that we would be most likely to consent to paternalism in those instances in which it preserves and enhances for the individual's ability to rationally consider and carry out his own decisions” (p. 103). In a scenario where a woman is pregnant and has already had difficulties with said pregnancy, it is easy to see the potential need for the capacity to make future rational decisions.

If there are any complications or needs for preemptive important procedures one would hope the individual or group can rationally decide what is the best course of action. Dworkin would argue that the doctors can withhold important information on the grounds that, in this scenario, a mother finding out her 7-year-old daughter has died would impair her ability of making rational decisions. I cannot help but agree with Dworkin. In the efforts of preserving the mothers autonomy to decide what is best for her, ie respecting her right to self determine, the doctors are acting paternally. Goldman would reject Dworkin's claim that in certain scenarios the doctor has the right to act paternally towards a person because of the individual's fundamental right to control the course of one's own life. Goldman states “. . . the most fundamental right is the right to control the course of one’s own life, to make decisions crucial to it, including decision in life or death medical contexts. ” (p. 109). Even in situations concerning relatives, life and death, the individual might have a uniques set of values or priorities that make self autonomy independently valuable (p. 109).

According to Goldman’s account of paternalism, the doctors have a duty to inform both the mother and father of the death of the child because withholding that information would be disregarding that individuals interests and self-governing ability. Within this viewpoint I cannot help but find certain admirable perspectives such as the respect of everyone's right to self-govern. This however, does not critically take into context the ability for certain situations to alter one’s ability to self-govern. There are scenarios where certain factors might contribute to an altered outlook. Ultimately contributing to a transformed sense of values and priorities, which Ackerman would argue, would render this person unsuitable to act on their own autonomy. Ackerman argues that the doctor has the right to intervene and act paternally how they see fit in regards to how patients receive information and treatment. This according to Ackerman then allows patients to effectively use the information to adjust their lives (p. 114). This means that Ackerman wholeheartedly supports paternalism because of the transforming effect of a lot of illnesses. Goldman claims the most fundamental right is the right to self-determination (p. 109) and I believe Ackerman would respond by indicating that in a situation regarding illnesses and potential life and death, one loses their autonomy or self-determination because of self-transformation.

The illness or situation might produce different values and priorities in a person so they cannot rationally decide what is best for themselves, essentially, they lose their self-golferning ability. I believe Ackerman would classify the loss of one daughter and the potential to lose a second child who has not even been born, as a transformative scenario that could potentially impair judgement. Ackerman uses the concept of impaired judgement to justify his standpoint that doctors can act paternally and I find myself agreeing with him on the basis of transformative instances removing our ability to rationally decide what is best for us. I personally believe that one’s ability to self-govern and self-determine is a very important liberty, so to act in a way that removes someone's ability to self-govern is something that is very difficult to agree with.

However, with the sheer amount of unique situational cases there can be regarding to one’s own ability to self-govern, I do find myself, to a certain extent, agreeing with Ackerman that there is a sort of transforming effect of illness. It is impossible to definitively say whether in all scenarios this transforming effect renders the individual unable to self-determine rationally. I do nevertheless think that often times when faced with illness or situations regarding life and death, priorities either change altogether or transform slightly meaning you cannot logically and rationally decide things because of the context of the situation. For this reason I do accept Dworkin's argument that in certain scenarios it is permissible to act in accordance to paternalism. More specifically it is permissible within the scope of the scenarios detailed by Ackerman, where one’s own autonomy has been compromised or transformed by an illness or situation.