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# Paternalism: soft, hard and why it declined

- Topic

Paternalism is deciding for another person, against their will, with the intention of doing them good.

Updated Nov 5, 2026

## Key points

- Soft paternalism: interfere only to check that the decision is voluntary and informed (or when the person lacks capacity).
- Hard paternalism: imposing one's own judgement on a capable, informed person; almost never justified.
- Classic examples: hiding a diagnosis «to avoid distress», giving a placebo deceptively, committing someone against their will.
- It declined with informed consent and patients' rights: from the doctor who decides to shared decision-making.
- Beneficence without respect for autonomy turns into paternalism.

## 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.

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## Connections

## Related 2

- [Beneficence](https://durgical.com/en/medical-ethics/beneficence/)
- [Respect for autonomy](https://durgical.com/en/medical-ethics/respect-for-autonomy/)

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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](https://plato.stanford.edu/entries/paternalism/) (Stanford Encyclopedia of Philosophy, 2020); [¿Qué es la deliberación en clínica? (Comprender los cuidados paliativos)](https://www.secpal.org/wp-content/uploads/2022/04/secpal-comprender-cuidados-paliativos-5-deliberacion-clinica.pdf) (Sociedad Española de Cuidados Paliativos (SECPAL), 2022); [Ley 23 de 1981, por la cual se dictan normas en materia de ética médica](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=68760) (Función Pública, Gestor Normativo (Colombia), 1981).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/paternalism-soft-hard-and-why-it-declined/