Paternalism, Family Duties, and My Aunt Maude
Miles, Steven H.
JAMA. 1988 May 6; 259(17): 2582-2583.
Using the case of his elderly great-aunt as an example, a physician raises the question of obligations toward elderly persons who refuse treatment that could improve the quality of their lives. Miles' aunt, blind, frail, and confined to a nursing home, refused cataract extraction that could restore her sight. Her family and physician scheduled the surgery, prepared to call it off if the aunt objected. The extraction was performed, the aunt's sight was restored, and her enjoyment of and participation in life increased significantly. Miles argues that the insistence upon autonomy and the proscribing of physician and family benevolence can be as abusive of patients as excessive paternalism. "As an absolute," he quotes, "autonomy reveals an impoverished view of how we live and are sustained in moral communities." (KIE abstract)