In the 18th century, medical paternalism was considered necessary. It was believed that only a doctor could properly understand symptoms and draw useful conclusions. During this period, the prevailing consensus was that disease was nothing more than symptoms. This meant that the individual history of the patient didn't matter in providing care, so the patient him or herself was irrelevant in the medical encounter. Thus it was deemed necessary that physicians make decisions for patients. This view of paternalism was only encouraged by the rise of hospitals in the later 18th century. Because patients in hospitals were often sick and disabled, the view of them as passive recipients of medical care only became more prevalent.
The models are as follows:
Activity—passivity refers to the traditional version of
paternalism, in which the doctor treats the patient as one who
cannot or should not make decisions. This relationship is similar
to that of a parent and child. Treatment is performed "irrespective
of the patient's contribution and regardless of outcome." This
model is considered justified in emergency situations in which
there is no time to consider the patient's preferences or
contributions.
Guidance—co-operation is a relationship used in more long-term
situations. The doctor provides instructions to the patient, to
which the patient is expected to comply. The name comes from the
expectation that the physician will guide the patient, who will
co-operate, but who retains their individuality.
Mutual participation involves the physician making it clear that
he or she is not infallible and does not always know what is best.
This model is more of a partnership, in which the doctor helps the
patient to help him or herself. This model is often employed in
cases of chronic disease or pain, in which the patient can have a
higher degree of freedom and be more independent of the
doctor
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