Palliative Paternalism

Palliative paternalism.  I really like this term and wish I had coined it.  But a group of UC-San Diego palliative care clinicians beat me to it.  At the March 2013 meeting of the American Academy of Hospice and Palliative Medicine, they will introduce and define "palliative paternalism," and discuss its role in patient care. 



The presenters explain that "autonomy is the current 'gold standard' approach to patient communication and has grown to the point that patient choice dictates care even when the choices are not possible or are medically futile." Furthermore, they observe "a trend among physicians where they avoid making difficult medical decisions by hiding behind the shield of patient autonomy."



The presenters define "palliative paternalism" as "an approach to communication with limited open-ended questions utilizing well-informed, discrete, concrete options during medical discussions in order to reduce confusion and suffering by avoiding futile care. Open-ended questions and unlimited care options may cause more harm in select high-risk patients: patients who are medically naïve or illiterate, have rigid or limited coping skills, belong to certain cultural groups known to mistrust the medical community, or have a history of substance abuse and/or a personality disorder."