PATERNALISM

Paternalists maintain that restricting the autonomy of persons is justified if these persons would be likely to cause serious harm to themselves or fail to secure an important benefit for themselves. The main ethical issue is whether paternalistic interventions are morally justified, and if so, under what conditions. In bioethics, rightful authority in the patient–physician relationship and public-health interventions have been the focus of the discussion. For health policy, paternalism is central to questions concerning the government's role in promoting healthy lifestyles and preventing self-caused injury and illness.

Many actions, rules, and laws are commonly justified by appeal to some paternalistic principle. Examples include laws that protect drivers by requiring seat belts; restrictions on the availability of drugs; rules prohibiting a healthy subject of biomedical research from voluntarily undergoing a high-risk procedure; overriding adult refusals of treatment; disclosing confidential information about a patient to protect the patient's health; involuntary commitment to hospitals; interventions to prevent suicides; and denial of an innovative therapy to someone who wishes to receive it. Laws are the usual vehicle for translating paternalistic beliefs into public policy, but individual actions and institutional policies can also have paternalistic roots.

Early History in Ethical Theory

In an eighteenth-century discussion, the philosopher Immanuel Kant denounced paternalistic government ("imperium paternale") for its benevolent cancellations of the freedoms of its subjects (pp. 58–59). However, it was the nineteenth-century English philosopher John Stuart Mill who presented the first systematic attack on paternalism, a term he avoided, in his 1859 monograph On Liberty:

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because in the opinions of others, to do so would be wise, or even right. These are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him …. In the part which merely concerns himself his independence is, of right, absolute. (p. 223)

Mill thus articulated a principle that properly restricted social control over individual liberty, regardless of whether such control is political, religious, or of some other type. He defended his principle with the utilitarian argument that granting people liberty rather than subjecting them to paternalism produces the best possible conditions for social progress and for the development of individual character and talent. Independent of his commitment to utilitarianism, Mill's On Liberty has played a more important role in discussion of paternalism than any treatise in ethical theory.

Neither Mill nor Kant anticipated that a paternal model of justified intervention into the affairs of competent adults might be extended to interventions with adult persons who, like children, have only a restricted or compromised capacity to choose autonomously. Yet this latter and broader model has become the most widely defended account of paternalism.

Definitions of Paternalism

The word paternalism refers loosely to acts of treating adults as a benevolent father treats his children, but the term has been given both a narrow and a broad meaning in ethical theory. In the narrow sense, paternalism refers to acts or practices that restrict the autonomy or liberty of individuals without their explicit consent; justification for such actions is either the prevention of some harm they stand to do to themselves, or the production of some benefit for them that they would not otherwise secure. This conception of paternalism leads to the following definition: Paternalism is the intentional limitation of the autonomy of one person by another, where the person who limits autonomy justifies the action exclusively by the goal of helping the person whose autonomy is limited (Dworkin, 1992; Beauchamp and McCullough). Following this definition, an act of paternalism overrides the value of respect for autonomy on some grounds of beneficence. Paternalism seizes decision-making authority by preventing persons from making or implementing their own decisions.

Many writers object to this analysis of paternalism because it does not comprehend the meaning of the term as it has descended from common usage and venerable legal precedent, where the notion is linked to guardianship, surrogate decision making, and government intervention to protect the vulnerable. The root sense of paternalism in ordinary language ("government as by a benevolent father") is joined with the law's wide-ranging use of terms such as parens patriae to produce a broad meaning that includes interventions into both autonomous and nonautonomous actions. Those who follow this broad vision recommend the following definition: Paternalism is the intentional overriding of one person's known preferences by another person, where the person who overrides justifies the action by the goal of benefiting the person whose will is overridden. Under this second definition, if a person's stated preferences do not derive from a substantially autonomous choice, overriding his or her preferences can still be paternalistic. The only essential condition of paternalism is beneficent treatment that overrides a known preference; a condition of substantial autonomy is not essential (VanDeVeer; Kleinig).

Defenders of the first definition argue that there are compelling reasons for resisting this second definition. First, paternalism originates in ethical theory as an issue about the valid limitation of freedom and autonomy. To include cases involving persons who lack substantial autonomy, such as drug addicts or the mentally disabled, broadens the term in a way that obscures the central issue, which is how, whether, and when liberty or autonomy can be justifiably limited. Second, the legal concept of parens patriae powers has its own subtleties and complexities. Courts do not apply this notion across the same range of thought and conduct that paternalistic literature treats as problematic. To incorporate a marginal legal doctrine together with the vagueness of ordinary language might prove more confusing than instructive in the end.

These two definitions are currently contested in literature. However, defenders of these two definitions need not disagree on all controversies about the meaning of paternalism. For example, it has sometimes been said that the term paternalism is inherently pejorative because it implies that authorities may treat adults such as hospital patients as if they were children lacking considered preferences of their own; therefore, they reason, the term is tainted by illegitimate authoritarianism or repressive dominance (Feinberg, 1980, 1986; Sherwin). Proponents of the above two definitions are free either to accept or to resist this interpretation. For example, they can both resist this pejorative meaning by arguing that paternalism suggests nothing beyond an analogy to respectable parental benevolence, in which parents act in the best interests of their children for good reason.

Weak (Soft) Paternalism and Strong (Hard) Paternalism

Joel Feinberg's distinction between weak and strong paternalism has profoundly affected literature on the subject. Although he switched to the language of "soft" and "hard" paternalism in his later work (1986), the terms "weak" and "strong" seem to have more deeply influenced the bioethics literature and will be used here.

In weak paternalism, one "has the right to prevent self-regarding harmful conduct only when it is substantially nonvoluntary or when temporary intervention is necessary to establish whether it is voluntary or not" (Feinberg, 1971,p. 113). This type of paternalism confines permissible limitations of autonomy to substantially nonautonomous (or nonvoluntary) behaviors. For example, it is permissible to pick up injured, partially incoherent victims of automobile accidents who refuse ambulance service and to admit against their will mentally ill persons who are dangerous to themselves. In strong paternalism, however, it is proper to protect or benefit a person by autonomy-limiting measures even if the person's contrary choices are autonomous. This paternalism supports interventions that protect competent adults against their will; that is, it controls or restricts substantially autonomous behaviors. For example, refusing to release a competent hospital patient who will die outside the hospital but requests the release knowing the consequences is an act of strong paternalism.

Weak paternalism is built on conditions of compromised ability or dysfunctional incompetence. When conduct that affects only the actor is restricted, some degree of autonomy may be present in the restricted actor, but the action must be substantially nonautonomous. Conditions that can significantly compromise the ability to act autonomously include the influence of psychotropic drugs, painful labor while delivering a child, and a blow to the head that affects memory and judgment. In medical situations, a patient's illness can be so devastating that it affects decisionmaking capacity. As the patient becomes weaker, less aware, or less alert, his or her dependence on the physician increases. A member of the medical profession who over-turns the preferences of a substantially nonautonomous patient in the interests of the person's medical welfare acts paternalistically and justifiably by the standards of weak paternalism. For this reason, weak paternalism has been widely accepted in law, medicine, and moral philosophy as an appropriate basis for intervention.

Strong paternalism, by contrast, supports some interventions intended to benefit a person whose choices and actions are informed and autonomous. Strong paternalism usurps autonomy by either restricting the information available to a person or overriding the person's informed and voluntary choices. These choices may not be fully autonomous or voluntary, but in order to qualify as strong paternalism the choices of the beneficiary of paternalistic intervention must be substantially autonomous or voluntary. For example, a strong paternalist would prevent a patient capable of autonomous choice from receiving diagnostic information that might lead to suicide. Unlike weak paternalism, strong paternalism does not require any conditions of compromised ability, dysfunctional incompetence, or encumbrance as the basis of intervention (although strong paternalists of course accept the justifiability of weak paternalistic interventions as well).

Justification of Paternalism and Antipaternalism

Defenders of paternalism in ethical theory have paid more attention to the justifying grounds for paternalism than to the type of paternalism justified. Some justifications range widely and defend both strong and weak paternalism. Typically, however, a condition in the argument states or hints that only weak paternalism is justified, although strong paternalism is the most controversial and interesting type of paternalism and may be the only type worth the effort of justification.

JUSTIFIED PATERNALISM. Defenders of paternalism often appeal to either a principle of rational consent or a principle of welfare or beneficence in order to justify their position. In one prominent justification, Gerald Dworkin argues that paternalism should be regarded as a form of "social insurance policy" that fully rational persons would take out for their protection (1972, p. 65). That is, paternalism is justified under conditions to which an impartial rational agent would consent if he or she were to appreciate the possibility of being tempted at times to make decisions to commit acts that are potentially dangerous and irreversible. The agent might at other times be driven to do something that would be considered too risky if he or she could objectively assess the situation—for example, smoking or drinking so heavily that health and life are endangered. A paternalistic health policy would remove or severely restrict the availability of tobacco and alcohol. In other cases, persons might not sufficiently understand or appreciate the dangers of their conduct, or might distort information about their circumstances. Seat-belt laws and motorcycle-helmet laws have often been enacted on this paternalistic basis.

Dworkin argues that a paternalistic act that denies a person an immediate liberty may paradoxically protect deep autonomy (i.e., the person's deeper values and preferences about the principles and standards on which he or she ought to act). A physician might lie to a patient, for example, in order to prevent a suicide, if the physician knows that the patient really wants to live and will later calm down and not commit suicide, although the patient is presently in no position to appreciate this fact. Dworkin argues that rational consent (consent that would be given) is the only acceptable way to express the conditions of justified paternalism. Many philosophers subsequently agreed with this thesis and made some form of consent a necessary condition of justified paternalism. However, justifications on bases other than consent have also been attempted (Dworkin, 1972; see VanDeVeer; and Kleinig).

A justification based on consent may do more to obscure than to clarify the issues. If the paternalist's objective is to protect or improve the welfare of another, then intervention can be justified by harm-avoidance or benefitproduction, as is the case in the justification of parental actions that override the wishes of their children. Children are treated paternalistically not because they will subsequently consent or would have consented were they rational, but because they will have better lives. This justification rests on providing for their welfare, not on respecting their autonomy.

THE JUSTIFICATION OF ANTIPATERNALISM. Some believe that paternalism is never justified. Mill supported this position, but with the important qualification that we are justified in restricting a person's liberty temporarily in order to ensure that the person is acting intentionally with adequate knowledge of the consequences of the action; once warned and informed, the person must be allowed to choose whatever course he or she desires. One need not be a follower of Mill's utilitarianism to defend this antipaternalism. For example, it can be defended by appeal to principles of respect for autonomy and privacy. Perhaps the most widely shared reason antipaternalists oppose (strong) paternalism is that it interferes with the authority of the individual, insults autonomous agents, and fails to treat them as moral equals (Childress).

The antipaternalist permits an initial, temporary infringement of liberty and privacy in the belief that persons who have a well-formed, autonomous resolution to do something harmful to themselves will have ample opportunity to perform the action after the temporary intervention has occurred. Intervention, in this limited respect, need not be a deep moral offense. Defenders of weak paternalism, however, view this qualified antipaternalism as insufficient because it disallows some highly desirable forms of intervention, such as long-term involuntary hospitalization for those in need of medical attention. Who, they reason, would not support altruistic beneficence directed at confused cardiac patients, ignorant consumers, frightened clients, and young persons who know little about the dangers of alcohol, smoking, drugs, and motorcycles? No caring and decent person would leave these individuals unprotected, and no reasonable philosopher would defend a normative thesis that permits such outcomes.

Weak paternalists thus project the appearance of steering a moderate and reasonable course between two radical and excessive extremes, strong paternalism and antipaternalism. The solution to the problem of paternalism, from their perspective, is to present the most defensible form of weak paternalism. But a severe stumbling block lies in the path of this tempting resolution of the issues: Weak paternalism has no clear substantive moral disagreement with antipaternalism, and therefore there is no reason to choose one over the other. Protection from harm caused to an individual by conditions beyond his or her knowledge and voluntary control—for example, by conditions beyond his or her self—is not an intervention that antipaternalists either criticize or disallow; they deny only the acceptability of intervention with substantially autonomous, self-caused harm. Weak paternalists too condemn such actions as an unjustifiable form of strong paternalism.

Weak paternalism, then, seems to be a defensible but noncontroversial position that virtually everyone accepts in some form. As Feinberg notes, it is "severely misleading to think of [weak paternalism] as any kind of paternalism," because weak paternalism is not "'paternalistic' at all, in any clear sense" (1986, pp. 12–14). Both weak paternalism and antipaternalism agree on the following critical claims:

• (a) It is justifiable to interfere in order to protect persons against harm from their own substantially nonautonomous decisions; and
• (b) it is unjustifiable to interfere in order to protect persons against harm from their own substantially autonomous decisions.

Weak paternalism is thus not a form of paternalism that can be distinguished in any morally important respect from antipaternalism. Weak paternalism does not seem to rest on a liberty- or autonomy-limiting principle independent of some moral principle of beneficence that supports prevention of harm to others (see Feinberg, 1971, pp. 107f., 124, and Feinberg, 1986, p. 13). Feinberg sarcastically suggests that the label "soft antipaternalism" seems to mean the same as "soft paternalism" (1986, p. 15).

The weak paternalist and the antipaternalist also join hands in opposition to the strong paternalist, who alone allows interventions that override and violate substantially autonomous actions.

THE JUSTIFICATION OF STRONG PATERNALISM. Although substantial autonomy is necessarily overridden in strong paternalism, conditions can be specified by a strong paternalist to restrict severely the range of justifiable interventions. For example, the strong paternalist might maintain that interventions are justified only if: no acceptable alternative to the paternalistic action exists; a person is at risk of serious harm; risks to the person that are introduced by the paternalistic action itself are not substantial; projected benefits to the person outweigh risks to the person; and any infringement of the principle of respect for autonomy is minimal.

Strong paternalism, so interpreted, will stand or fall on the strength of the argument that major welfare interests under some specifiable conditions legitimately override relatively minor autonomy interests. Many cases can be found that fit this model. For example, when healthy persons with no heart disease volunteered as subjects in a research study to have an artificial heart transplanted at the University of Utah, it was entirely reasonable that a review committee declared that the risk relative to benefit for a healthy subject is morally unacceptable and that they should not be allowed to undergo the procedure (Beauchamp and Childress).

Issues of Paternalism in Bioethics

Many examples of controversial paternalistic justifications are found in bioethics. Only a few general topics are treated here.

OVERRIDING REFUSALS OF TREATMENT. It is sometimes controversial whether procedures should be withheld or withdrawn even when the patient refuses the procedures. Justifications for overruling a patient's refusal of therapy need not be paternalistic, but they often are paternalistic because their objective is to prevent harm that would be caused by the patient's refusal. The issue is not whether a physician actually knows what is best for the patient, but whether the patient has a right to refuse treatment even if the refusal is harmful and the treatment beneficial.

Persons of questionable competence who refuse therapy present delicate moral problems and difficult conceptual issues about whether interventions are paternalistic. For example, do schizophrenic patients have a right to refuse a therapy for dehydration if a physician determines it to be safe and efficacious, and would an intervention after a refusal be paternalistic? Similarly, do children who understand what is being done to them have a right to refuse therapies when their parents and physicians judge these therapies to be essential, and are such interventions paternalistic?

OVERRIDING REQUESTS FOR TREATMENT. Patients or their legal representatives occasionally request medical procedures that physicians believe are harmful, ineffective, or futile. The physician may then refuse to act on these requests for paternalistic reasons. If the requests by patients are incompatible with accepted standards of care or conflict with the physician's conscientious beliefs about standards of care, a physician's refusal to comply may be justified for these apparently nonpaternalistic reasons of appropriate physician conduct. Nonetheless, the interventions are pater-nalistic whenever the primary ground of noncompliance with the request is that the treatment is not in the patient's best interests. Moreover, setting professional standards of practice is itself often a paternalistic attempt to protect patients' interests, and as such may be either justified or unjustified paternalism (Childress; Brett and McCullough). The same argument can be applied to drug policies of a government agency that refuses to accept requests for experimental therapies on grounds of risk to patients.

PARTIAL DISCLOSURES TO PREVENT HARM. Physicians and families often argue that a particularly devastating diagnosis or prognosis should not be disclosed to a patient. The concern is that bad news might adversely affect the patient's health or lead the patient to commit suicide. If the patient asks for the information or expects a truthful disclosure, it is paternalistic to withhold the truth. Physicians also occasionally make difficult medical decisions without consulting the parents of seriously ill newborns. These actions too are paternalistic if the objective is to prevent anguish to the parents. Other examples extend beyond serious patient illness. For example, genetic counselors sometimes use potential marital conflict for a patient as a reason not to disclose a condition such as nonpaternity, thereby depriving a patient of information generated in part by materials the patient provided.

In a much-quoted article on medical ethics, L. J. Henderson claimed that "the best physicians" use the following as their primary guide: "So far as possible, 'Do No Harm.' You can do harm by the process that is quaintly called telling the truth. You can do harm by lying…. But try to do as little harm as possible, not only in treatment with drugs, or with the knife, but also in treatment with words"(p. 823). The premise that some information may legitimately be withheld or disclosed only to the family for the patient's good is a clear instance of this rule and an equally clear case of paternalism. Why the family, rather than the competent patient, is given the information without the patient's prior permission is itself an important issue concerning paternalistic medical practices.

INVOKING THE THERAPEUTIC PRIVILEGE. Therapeutic privilege is a legally recognized privilege of the physician to withhold information from a patient if disclosure would cause serious deterioration in the physical, psychological, or emotional condition of the patient. This privilege has long been used in clinical settings to justify not obtaining consent and has elicited a particularly furious exchange over whether autonomy rights can be validly overridden for paternalistic reasons.

The courts have yet to develop a standard for appropriate use of the therapeutic privilege that renders it coherent with requirements of informed consent. If stated broadly, physicians can withhold information when disclosure would cause any countertherapeutic deterioration, however slight, in the physical, psychological, or emotional condition of the patient. If stated narrowly, physicians can withhold information if and only if the patient's knowledge of the information would have serious health-related consequences—for example, by jeopardizing the success of the treatment or harming the patient by critically impairing relevant decisionmaking processes. Confusion has also surrounded appropriate measures of rationality, psychological damage, and emotional stability under the standard of therapeutic privilege. Loose standards can permit physicians to climb to safety over a straw bridge of speculation about the psychological consequences of information, and this threat of abuse has made the therapeutic privilege highly controversial.

HEALTH POLICY FOR EXCESSIVE RISK. Antipaternalists argue that paternalistic standards for policy would authorize too much intervention. Paternalism could in principle prohibit smoking, drinking, and hazardous recreational activities such as hang gliding, mountain climbing, and white-water rafting, making such activities subject to criminal sanctions. Careful defenses of paternalism would disallow these extreme interventions, and at best antipaternalist arguments establish only a rebuttable presumption against paternalistic intervention. Nonetheless, antipaternalists are convinced that an unacceptable latitude of judgment would remain in contexts in which power is subject to abuse. Strong paternalism suggests that it would be permissible and perhaps obligatory to restrain and punish those who violate paternalistic rules. If so, antipaternalists argue, the state would be permitted to coerce morally heroic or valiant citizens if they act in a manner "harmful" to themselves. More generally, the state would be empowered to take away from persons the right to make decisions about their lives whenever officials view risks as excessive.

GOVERNMENT AGENCY RESTRICTIONS. Some government bureaus can be viewed, at least in part, as paternalistic guardians. For example, the Food and Drug Administration (FDA) in the United States is chartered to restrict persons from purchasing foods, drugs, and medical devices that are unsafe or inefficacious. A controversial decision by the FDA in 1992 to severely restrict the use of silicone-gel breast implants exemplifies paternalistic controversies that have beset the FDA. Women had elected implants for over thirty years, either to augment their breast size or to reconstruct their breasts following mastectomies. Over two million women in the United States had had these implants (three million worldwide) when, in April 1992, the FDA restricted the use of silicone-gel breast implants until additional studies could be conducted to establish their safety. Concerns centered on the implants' longevity, rate of rupture, and link with various diseases. Those who defended complete prohibition contended that no woman should be allowed to take a risk of unknown but potentially serious magnitude because her consent could not be informed. The FDA defended a restrictive policy, rather than prohibition, holding that patients with breast cancer and others have a legitimate need for breast reconstruction. The FDA distinguished sharply between reconstruction candidates and augmentation candidates, arguing that the favorable risk–benefit ratio is confined to reconstruction candidates (Kessler).

Critics of this decision charge that the government's decision is inappropriately paternalistic, especially in contrast to the more permissive public decisions reached in European countries. These critics argue that subjective benefits for many women outweigh the identified risks, and opinion surveys indicate that 90 percent of women receiving the implants are satisfied with the results (see Parker). Critics argue that the only defensible policy is to permit the continuing use of silicone-gel breast implants while requiring adequate disclosure of information about risks. Raising the level of disclosure standards is, from this perspective, more appropriate than raising the level of paternalistic restraints on choice.

THE MODEL OF PATERNAL AUTHORITY. The term paternalism has often been criticized as sexist and in need of correction to parentalism. However, some feminists in bioethics as well as some critics of paternalistic medical practices have argued that this usage is a rare case in which gendered language should be retained on grounds that an appropriate link is made between the privileges of a father in a patriarchical family and the privileges of physicians in an authoritarian medical system. The thesis is that just as hierarchical arrangements have long been the norm in the family, so paternalism has been the norm in medicine; to appreciate the need to revise authority structures in the family should similarly point to the need to revise the model of rightful authority in medicine (see Sherwin).

This criticism extends beyond analysis of the meaning of paternalism. It assumes the persistence among physicians, male and female, of the belief that a paternal model of authority is requisite in clinical practice because of compromised reasoning abilities in patients, the essential need for technical information in medical decision making, and the needs many patients have for an authority figure as healer. Susan Sherwin (1992) and other writers in bioethics have argued for replacing this traditional paternalistic model with a radically different model of the physician–patient relationship, such as a model based on friendship or on contract.

However, those who support justified paternalism in medicine believe that paternalism, properly understood, fits coherently with our normal expectations of altruistic beneficence and fiduciary responsibility in professional healthcare relationships. Their model is that of a dedicated professional who possesses superior knowledge, experience, and skills and who seeks to further a patient's best interest. Whether pieces of these two starkly different models can be joined consistently is a matter of widespread controversy in bioethics.

SUICIDE INTERVENTION. Many views about reporting, preventing, or intervening in suicide are paternalistic. Because of the extreme and irreversible effects of suicide, some defenders of intervention believe that a principle of respect for life creates an obligation to prevent suicide that overrides obligations based on the principle of respect for autonomy. A weaker account relies on Mill's strategy: Intervention is justified to establish autonomy in the person; but after it is determined that the person's decisions are substantially autonomous, further intervention would be unjustified. (Kleinig discusses several other paternalistic arguments for suicide intervention.)

Both this weaker account and stronger accounts have been defended on grounds that others do sometimes know our best interests with more insight and foresight than we do. It is often difficult to know how much ability persons have to act autonomously or how much insight they have into their "best interests." The stronger account is also defended on grounds that many suicidal persons are under intense strain or the influence of drugs or alcohol, clinically depressed, destabilized by a crisis, or simply wish to end their pain, and that these persons can be helped with their problems by health professionals. Another defense is that failure to intervene symbolically communicates to potential suicides an absence of communal concern and diminishes a feeling of communal responsibility. Finally, some argue that it is a justified form of paternalism for friends and healthcare professionals to infringe confidentiality by reporting suicide threats to those who may be in a position to help prevent the acts. Some even defend a paternalistic obligation to report suicide threats (Bloch).

INVOLUNTARY INSTITUTIONALIZATION. Finally, a vast literature surrounds the involuntary hospitalization of persons who have never harmed others or themselves but are thought to stand in danger of inflicting such harm or of being vulnerable to harm by others. A major part of the contemporary rationale for use of police powers for the emergency detention and civil commitment of those dangerous to themselves is a paternalism supported by the knowledge that treatment has often helped persons over a momentary crisis. These interventions can involve a double paternalism: a paternalistic justification for commitment and a paternalistic justification for forced therapy (e.g., psychotherapy) after commitment.

Conclusion

Bioethics in the 1970s and 1980s exhibited a strong tendency to reject paternalism as an unjustified tampering with autonomy. However, from the mid-1980s through the mid-1990s many voices began to be heard that were more sympathetic to various paternalistic appeals. Paternalism seems likely to continue to be a viewpoint that will gain or lose adherents as the issues and larger social context shift. We may never again see the concentrated flurry of scholarly interest in this subject that was exhibited from the mid-1970s to the mid-1980s, but paternalism is not likely to be an issue that will soon disappear.

tom l. beauchamp (1995)

SEE ALSO: Autonomy; Behavior Control; Beneficence; Coercion; Freedom and Free Will; Institutionalization and Deinstitutionalization; Professional-Patient Relationship; Public Health; Suicide

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