How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making

ABSTRACT

We conducted an empirical study to explore clinician and lay opinions on the acceptability of physician paternalism. Respondents read a vignette describing a patient with brain hemorrhage facing urgent surgery that would be lifesaving but would result in long-term severe disability. Cases were randomized to show either low or high surrogate distress and certain or uncertain prognosis, with respondents rating the acceptability of not offering brain surgery. Clinicians (N = 169) were more likely than nonclinicians (N = 649) to find the doctor withholding surgery acceptable (30.2% vs. 11.4%, p ≤ 0.001). Among clinicians, the doctor withholding surgery was more acceptable when prognosis was certain to be poor (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.04, 4.01). There was no effect of surrogate distress on clinician ratings. Responses among lay public were more variable. Given the differences in attitudes across clinicians and lay public, there is an ongoing need to engage stakeholders in the process of end-of-life decision making.

KEYWORDS:

• brain injury
• medicine
• end-of-life issues
• decision making
• professional–patient relationship

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.

Acknowledgments

We acknowledge the support of the Center for Bioethics and Social Sciences in Medicine in helping design this project. We also thank all the participants who contributed to this study.

Author contributions

All authors contributed to the conception, design, and revisions to drafts. KB and DZ collected data and wrote the primary draft. DZ conducted the analysis.

Ethical approval

This study was reviewed by the University of Michigan Health Science Behavioral Science Institutional Review Board and determined to be exempt from review.

Additional information

Funding

This work was partially supported by the National Institutes of Health (NIH) grants T32HL00749 and K23038731. The NIH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the article.