There Was No Paternalism in the Li Case

Over at Oxford's Practical Bioethics, Domenic Wilkinson suggests that Sunnybrook Health's providers were paternalistic in issuing the unilateral DNR order in Toronto's Li case.  He writes:  "The statement by Sunnybrook hospital executive appears to be based on the first reason. What doctors are saying in effect is, “we know that you want this treatment, and you think that it would benefit you, but we know better”  I disagree.

I do not think that refusals to provide non-beneficial treatment are paternalistic.  It is almost never the patient herself contemporaneously asking for the aggressive interventions.  It is the patient's surrogate.  When providers resist the surrogate's demands, they usually doubt that the surrogate is really doing what the patient wanted.  Here, in the Li case, the patient had an extensive written advance directive.  But he did not anticipate the precise circumstances that obtained this week.  Therefore, it is not the case that the patient AUTONOMOUSLY chose X and the providers chose Y.  Rather, the providers (and ultimately the family too) was skeptical that the patient actually chose or wanted X.  This is soft paternalism (aka weak paternalism), not really a form of paternalism at all.