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environment, it seemed obvious that health professionals knew the best interests of their
patients and would always act to promote them.
A number of high profile incidents have undermined the unwavering confidence of the
public in health professionals. For example, the Cartwright report (1988) was a
damning indictment of research into cervical cancer at National Women’s Hospital in
Auckland, New Zealand. More recently in England the Bristol Inquiry investigated
poor paediatric cardiac surgical practices (Kennedy, 2001). Along with these incidents
have been growing consumerist and rights based societies questioning the assumptions
which uphold the traditional medical decision making model.
The new paradigm questions the validity of the value-free medical model in the
decision making of health professionals (See Fulford, 2004; Kennedy, 1981, p. 78;
Little, 2003; Seedhouse, 2005; Spiers, 1997, p. 54; Veatch, 1995, p. 4). Growing
evidence paints a more realistic picture of the values which guide clinical decisions. For
example, Holloway, Benesch, Burgin and Zentner (2005) found research demonstrating
that physicians’ personal characteristics, including age, race, religion, time in clinical
practice, religion, gender and degree of burnout, are influential in decisions about
whether to continue or withdraw life sustaining treatment for patients following severe
stroke. As Bieglar observed “being good at medicine does not necessarily translate into
moral expertise at moral judgment for others” (2002, p. 61).
The conflict between the new and the old paradigm
The new paradigm is in direct conflict with the old paradigm. The call for the
recognition and transparency of values in health care is simply incompatible with the
dominant philosophical approach. In accordance with Kuhn’s theory of scientific
revolution, this has created tension between the people supporting the new paradigm
and those in the old camp. In the new camp people are no longer prepared to accept
without question the clinical judgement of health professionals, particularly concerning
grave treatment decisions. In the old camp, health professionals recognise their
vulnerability in the new environment where their decisions are no longer accepted
without question. What has resulted in this period of conflict is uncertainty about the
decisions made on behalf of incapacitated adults and how they are made.
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