Public Health Law Map - Beta 5 - Medical and Public Health Law Site

from religious beliefs. Understanding law and lawyers requires an appreciation of legal
belief systems, as well as the statutes and cases.
1. Paternalism in Medicine
Paternalism has become a politically unpopular word because of its association with
physicians telling patients what is good for them, without regard to the patient’s own
needs and interests. This limited sense of paternalism is improper and has been
obviated by informed consent requirements. In the larger sense, however, the
relationship between medical care practitioners and patients is a paternalistic,
beneficent relationship: the medical care practitioners are expected to do what is
medically best for the patient. While that might even include assisted suicide in an
extreme case, it never includes improper medical care given only because the patient
requests it. Despite the importance of patient involvement and informed consent,
medical care practitioners are expected to do what is best for their patients. In certain
public health situations, they are also expected to consider what is best for society,
even if that may not be in the best interests of the patient.
The courts’ skepticism in cases in which patients allegedly make an informed choice
of medically improper treatment highlights the expectation that physicians will offer
patients only the choice of medically proper and indicated treatments. This reflects a
general societal consensus on what constitutes acceptable medical care. In most
cases, physicians, patients, and society agree on the desired outcome and the
appropriate spectrum of treatments to accomplish that outcome. While this is not
meant to minimize the very real conflicts between physicians and patients, debates
over contentious issues such as abortion, right to die, and entrepreneurial medical
practice tend to obscure the congruence of interests that define the vast majority of
patient care.
2. Attorneys and Autonomy
The attorney–client relationship, in contrast, is based on autonomy rather than
paternalism. Law is an adversarial process with many areas in which there is no clear
societal consensus on the correct role of the attorney. Respecting a person’s
autonomy can mean protecting a mentally ill homeless person’s right to freeze under
a bridge or the right of a person to refuse simple, life-saving medical care. Short of
helping clients commit crimes, attorneys are expected to advocate their clients’
wishes zealously, not limit their services to those that are good for the client. Unlike
medical care practitioners, attorneys have only a very limited role in controlling the
impact of their client’s actions on society.
Beyond this philosophical prejudice toward client autonomy, traditional codes of
legal ethics limited the attorney’s obligation to do the legal equivalent of a complete
history and physical. These ethical codes created the limited engagement doctrine.
The limited engagement defined the attorney’s role as providing the specific legal
services sought by the client. In its strictest form, the limited engagement doctrine
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