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n. an attitude or policy that overrides a person’s own wishes (autonomy) in pursuit of his or her best interests. Such an approach is contrary to the Kantian imperative to treat people as ends in themselves and never as a means to an end. The question of when, if ever, a measure of paternalism may be justified remains one of the most contested in ethics. The philosopher John Stuart Mill argued that intervention was justified only when trying to prevent a person from causing harm to others, not to himself. In practice, however, we accept certain paternalistic constraints in our everyday lives lives in the interests of welfare, such as the legal requirement to wear seat belts when driving. In general, Western medical ethics takes the view that the autonomy of the individual is paramount and his or her wishes are sacrosanct. However, a form of paternalism may be justified when a person lacks the capacity to make decisions for him- or herself, assuming there is no valid advance statement, decision, or directive or a proxy with lasting power of attorney to represent the patient’s wishes. See also therapeutic privilege. —paternalistic adj.

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