New types of relationship between doctor and patient are often presented as surpassing the so-called paternalistic model whereby doctors treated patients in the same way that fathers treat small children who are not yet able to understand what is for their own good.

Now it is emphasised everywhere that doctors must not behave paternalistically, but they must, instead, treat patients as adults capable of assessing what is in their best interests and even the course of action to be taken. It is from this central point that the idea that informed consensus could limit medical intervention on the body of the patient originates. And also from here that we get the continually negative use of the term ‘paternalism’, now used to signify ‘offending the dignity of the sick person’.

But can we be certain that, in medicine, paternalism is always so damaging? And, above all, can we be sure that the alternative to paternalism is always practical?

Certainly, the ideal relationship between doctor and patient is one based on a transparent and informed dialogue, in which the doctor assesses the various options with the patient and they agree on a care plan. Unfortunately, in many cases this ideal seems like an unrealistic and even dangerous utopia. Think, for example, of the growing number of situations in which the patient (like a later-stage Alzheimer sufferer) is unable to have this dialogue with their doctor. There are also many cases in which the patient cannot fully understand their doctor’s proposed care plan, as it is too technically complex. There is a risk that patients who are unable to have such a relationship with their doctor will be abandoned and left with empty formal procedure. Paternalism, on the other hand, acted out in science and conscience, always implies the doctor taking it upon themselves to act in the patient’s best interests.

Besides, if we abandon paternalism entirely, the majority of safety regulations would not make sense (issued to favour correct behaviour in the best interests of patients), nor would all the social campaigns directed at encouraging healthier lifestyles.