Choosing the Best: Against Paternalistic Practice Guidelines

Isobel Ross rightly points out that providing information is not enough to guarantee that patients will choose the best course of action. She argues that to adequately protect patients' interests, we need practice guidelines to ‘ensure that dangerous and unnecessarily risky procedures are excluded from practice’. What constitutes an ‘unnecessarily risky procedure’ is to be determined by a group of reasonable doctors. At one point, Ross suggests that such guidelines are ‘presumptive’ rather than ‘absolute’. But this is really a concession to patient variability. She intends that certain procedures are ruled out on paternalistic grounds. I will argue that practice guidelines are desirable but should not determine practice. We should not rule out procedures on paternalistic grounds.