Paternalism has implications for compassion in healthcare because it shows a basic flaw in the doctor/patient relationship that can also apply to other healthcare staff and patients in any situation. Doctors like to think their procedures help patients and often find it difficult to admit that harm may result instead of, as well as, some improvement. That’s understandable. But they harm patients just by being blinkered in this way. And I think the problem lies even deeper – it’s lack of respect for the patient as a person
Patients are in the hands of others – they are to be ‘done to’. Other people hold the knowledge they need, have authority over them and can do uncomfortable and painful things to them. This attitude is perpetuated by the hierarchal system – those with least authority or who have never previously had meaningful authority, sometimes becoming the worst offenders. It’s easy to enjoy a position of authority; it’s especially easy to feel powerful over vulnerable people. And power can cloud the mind – like a drug. It can lead to lack of respect for their charges, and in the worst cases to neglect and abuse as seen recently in the UK in care homes for eg people with learning difficulties – and Stafford Hospital – and elsewhere (other hospitals are now being investigated).
I think something that should be taught in medical schools and all teaching establishments allied to health is: it is easy to feel superior when in charge of vulnerable people
Respect for vulnerable people should be embedded in all health-related teaching (and if it is already, it needs to be reinforced!). And I’m not writing this to be provocative, but because counselling cancer patients was my first experience of helping vulnerable people. And helping them made me feel good – fulfilled – and in a position of power. But I realised the danger – that this could easily make me feel superior. My training had taught me not to feel ‘ownership of the patient’, not to allow clients to become too dependent on me, but rather to signpost support from other sources as appropriate, as well as enable them to move on in their lives. I’m sorry, but I could quote many examples of paternalism and of healthcare staff having tussles over patient ‘ownership’, with deleterious effects on patients
He is a great man who does not cling to power…