Blind Trust in the Care-Giver: Is Paternalism Essential to the Health-Seeking Behavior of Patients in Sub-Saharan Africa?


In the past, patients put their lives in the care of doctors in blind trust that the doctors would care for them. This kind of trust is no longer common particularly in the western industrialized nations but the same cannot be said about patients in Ghana and Sub-Sahara Africa. The first concern was whether paternalism was essential in medical practice in Ghana. The second was whether paternalism as an ethical standard should be considered from the ethical lens of the western industrialized nations, rather than from the African cultural context. This entailed a review and examination of the literature on paternalism. We searched databases such as PubMed, Medline and others for reports, editorials and published papers in the English Language. A search on Goggle Scholar on “paternalism in medical practice in Africa” yielded over 380,000 entries and “paternalism in medical practice in Ghana” yielded 2.1 million but more than 99% were not relevant in each instant. Hand searching of selected printed journals and grey literature such as technical reports, conference proceedings and workshops were also assessed. The studies that met the inclusion criteria were given additional review but those with poor methodology were excluded but discussed in this review. I assigned an overall score and identified the position taken in the publication or report in relation to the objectives and rated them objectively. The papers that received scores above 2.5 out of 4 in the evaluation were further analyzed. I summarized the findings into their respective units, and interpreted them based upon my skills, knowledge and specialization in medico-legal ethics, public health and law. The result shows that not enough research has been done on whether or not paternalism should be encouraged as a regular feature of medical practice in Ghana due to the lack of education. It also shows that paternalism enhances the health seeking behavior of patients despite developments on patient autonomy and capacity. Where the average patient is illiterate in general and in medical matters, the paternalism of the physician may be inevitable. Ethical standards such as Informed Consent, Autonomy, Due Process, Benevolence and No malfeasance should be defined and operationalized in clinical practice within the cultural context of Sub-Sahara Africa. A systematic indigenization of medico-legal ethical concerns in medical practice is needed in Ghana.

Share and Cite:

Norman, I. (2015) Blind Trust in the Care-Giver: Is Paternalism Essential to the Health-Seeking Behavior of Patients in Sub-Saharan Africa?. Advances in Applied Sociology, 5, 94-104. doi: 10.4236/aasoci.2015.52008.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Beauchamp, T. L., & Childress, J. F. (2001). Principles of Biomedical Ethics (5th ed.). Oxford: Oxford University Press.
[2] Braddock III, C. H., Edwards, K. A., Hasenberg, N. M., Laidley, T. L., & Levinson, W. (1999). Informed Decision Making in Outpatient Practice: Time to Get Back to Basics. Journal of the American Medical Association, 282, 2313-2320.
[3] Braddock, C. H., Fihn, S. D., Levinson, W., Jonsen, A. R., & Pearlman, R. A. (1997). How Doctors and Patients Discuss Routine Clinical Decisions: Informed Decision-Making in the Outpatient Setting. Journal of General Internal Medicine, 12, 339-345.
[4] Bradt, D. A. (2009). Evidence-Based Decision-Making in Humanitarian Assistance. Humanitarian Practice Network, Overseas Development Institute, 1-24.
[5] Buchanan, D. R. (2008). Autonomy, Paternalism, and Justice: Ethical Priorities in Public Health. American Journal of Public Health, 98, 15-21.
[6] Castellano Marlene, B. (2004). Ethics of Aboriginal Research. Journal of Aboriginal Health, 1, 98-114.
[7] Dworkin, G. (1988). The Theory and Practice of Autonomy. Cambridge: Cambridge University Press.
[8] Edelstein, L. (1943). The Hippocratic Oath: Text, Translation and Interpretation. 56.
[9] Edwin, A. K. (2008). Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege—Is It Ever Justified? Ghana Medical Journal, 42, 156-161.
[10] Edwin, A. K. (2009). Non-Disclosure of Medical Errors an Egregious Violation of Ethical Principles. GMJ, 43, 34-39.
[11] Elizabeth Vaah v. Lister Hospital and Fertility Centre (2010). Suit # HRCM 69/10.
[12] Emmanuel, E. J., & Emmanuel, L. I. (1992). Four Models of the Physician-Patient Relationship. Journal of the American Medical Association, 267, 2221-2226.
[13] Emmet v. Eastern Dispensary and Casualty Hospital (1967). 130 U.S. App. D.C. 50, 396 F 2d 931.
[14] Francis, L. P. (2010). The Physician-Patient Relationship and a National Health Information Network. Journal of Law, Medicine and Ethics, 38, 36-49.
[15] Ghana Public Health Act (2012). Act 851. Government Printers, Barnes Avenue, Opp. Novotel Hotel, Accra, Ghana.
[16] Ghana Statistical Service (2010). The Annual Statistical Survey. Ghana Statistical Service, Ministries, Accra, Ghana.
[17] Gillion, R. (1985). Paternalism and Medical Ethics. British Medical Journal, 290, 1971-1972.
[18] Goodman, K. W. (2010). Ethics, Information Technology, and Public Health: New Challenges for the Clinician-Patient Relationship. Journal of Law, Medicine and Ethics, 38, 58-63.
[19] Gostin, L. O. (2005). Jacobson v Massachusetts at 100 Years: Police Powers and Civil Liberties in Tension. American Journal of Public Health, 95, 576-581.
[20] Gostin, L. O., & Hodge, J. G. (1999). Model State Public Health Privacy Act (pp. 1-59). Washington DC: Georgetown University Law Center.
[21] HIPAA (1996). U.S. Public Law (pp. 104-191).
[22] Holland, S., & Public Health Ethics (2010). Cambridge: Polity Press, 50.
[23] Jacobson v. Massachusetts, 197 U. S. 11 (1905).
[24] Mills, J. S. (1977). 15. On Liberty. Collected Works of John Stuart Mill (Vol. 18). Toronto: Toronto University Press.
[25] Moulton, B., & King, J. S. (2010). Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice. Journal of Law, Medicine and Ethics, 38, 85-97.
[26] National Television Penetration Statistics.
[27] Nigerian Orders Arrest of Pfizer Defendants.
[28] Norman, I. D., Aikins, M., & Binka, F. (2010). Ethics and Electronic Health Information Technology, Challenges for Evidence-Based Medicine and the Physician—Patient Relationship. Galen Medical Journal, 43, 115-125.
[29] Norman, R. J. (2005) Autonomy in Applied Ethics. In T. Honderich (Ed.), The Oxford Companion to Philosophy (New Edition, p. 72). Oxford: Oxford University Press.
[30] Nussbaum, M. C. (1993). Non-Relative Virtues: An Aristotelian Approach. In M. Nussbaum, & A. Sen (Eds.), The Quality of Life. New York: Oxford Clarendon Press.
[31] O’Neill, O. (2002). Autonomy and Trust in Bioethics (pp. 126-136). Cambridge: Cambridge University Press.
[32] Peterson-Iyer, K. (2008). Pharmacogenomics, Ethics and Policy. 1-16, Markkula Center.
[33] Rothstein, M. A. (2009). Improve Privacy by Eliminating Informed Consent? IOM Report Misses the Mark. Journal of Law, Medicine & Ethics, 37, 507-509.
[34] Rothstein, M. A. (2010). The Hippocratic Bargain and Health Information Technology. Journal of Law, Medicine and Ethics. 38, 7-13.
[35] Sen, A. (1992) Capability and Well-Being. In M. Nussbaum, & A. Sen (Eds.), The Quality of Life. New York: Oxford Clarendon Press.
[36] Sivalingam, N. (2011). Medical Paternalism and Patient Autonomy; the Dualism Doctors Contend with. Medical Journal of Malaysia, 66, 421-422.
[37] Szasz, T. S., & Hollender, M. H. (1956). The Basic Models of the Doctor-Patient Relationship. Archives of Internal Medicine, 97, 585-592.
[38] Tassano, F. (1995). The Power of Life or Death: Medical Coercion and the Euthanasia Debate. Foreword by Szasz, T. MD. London: Duckworth; Oxford: Oxford Forum.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.