Paternalism: soft, hard and why it declined
- Topic
Paternalism is deciding for another person, against their will, with the intention of doing them good.
What it is
Paternalism is interfering with a person's decision, without their agreement, to protect or benefit them. For centuries it was the model of the doctor-patient relationship: the doctor, who knew, decided; the patient obeyed. From the second half of the 20th century, the patients' rights movement, informed consent and research ethics shifted the model towards shared decision-making. Today soft paternalism, accepted in limited cases, is distinguished from hard paternalism, which is almost never justified with a capable adult.
Key facts
- The distinction between soft and hard paternalism is credited to the philosopher Joel Feinberg.
- Another distinction: weak paternalism corrects mistaken means to the person's own ends; strong paternalism corrects their ends.
- The paternalist model counted the doctor's values and not the patient's; today's deliberation includes the values of both.
In clinical practice
- Before accepting a serious refusal, it is legitimate to check that the person understands and decides freely: that is soft paternalism.
- If the patient is capable and informed, pressing or deceiving them into agreeing is hard paternalism.
- Shared decision-making is the alternative: the doctor brings knowledge and a recommendation; the patient brings their values and decides.
- Protecting someone without capacity (in an emergency, for example) is not unjustified paternalism.
Legal framework in Colombia
- Colombia's Law 23 of 1981 requires asking for the patient's consent (art. 15) and respecting their freedom to do without the doctor's services (art. 8).
- The text of Law 23 was checked on 2026-11-05 in the Función Pública Gestor Normativo.
Test yourself
Think of the answer, then tap the question to see it.
What is the difference between soft and hard paternalism?
Soft paternalism interferes only to check that a decision is voluntary and informed, or when the person lacks capacity; hard paternalism overrides a capable, informed person.
Is hiding a diagnosis from a capable patient «to avoid distress» paternalism?
Yes. It is a classic example of paternalism; the patient has a right to the information unless they themselves ask not to receive it.
Which model replaced paternalism in the clinical relationship?
Shared decision-making, based on informed consent: the doctor informs and recommends, and the capable patient decides.
Which article of Colombia's Law 23 of 1981 recognises the patient's freedom to do without the doctor's services?
Article 8.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Paternalism (Stanford Encyclopedia of Philosophy, 2020); ¿Qué es la deliberación en clínica? (Comprender los cuidados paliativos) (Sociedad Española de Cuidados Paliativos (SECPAL), 2022); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo (Colombia), 1981).
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Representative model, for educational purposes only.