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Editorials |

“My Advice Is . . .”: Beneficent or Veiled Paternalism

Constantine A Manthous, MD, FCCP
Author and Funding Information

From the Yale School of Medicine.

Correspondence to: Constantine A. Manthous, MD, FCCP, 4450 Whitney Ave, Hamden, CT 06518; e-mail: manthous@sbcglobal.net


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):243-244. doi:10.1378/chest.10-1436
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In this issue of CHEST (see page 424), Swindell et al1 explore the notion of shaping patients’ decisions, also known as framing. They suggest that “it seems impossible for physicians to fully extricate their own values from the way in which they communicate with their patients,” so “the ethical task for the conscientious clinician is not to avoid influencing choice, but to avoid restricting choice.” They argue that patients rarely correctly understand the decision at hand and its multiple potential consequences. Not all patients want or are able to exercise positive liberty, as described by the authors. And even if it were appropriate to extricate our values from patients’ decision making, it is not clear that patients would benefit or be unburdened. In light of these limitations, respect of autonomy should not always trump our obligations of beneficence, nonmaleficence, and justice. Rather, shared decision making may use careful framing to simultaneously balance and serve all four ethical obligations.

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