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.
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. http://dx.doi.org/10.1001/jama.282.24.2313
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.
Emmanuel, E. J., & Emmanuel, L. I. (1992). Four Models of the Physician-Patient Relationship. Journal of the American Medical Association, 267, 2221-2226. http://dx.doi.org/10.1001/jama.1992.03480160079038
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. http://dx.doi.org/10.1111/j.1748-720X.2010.00466.x
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. http://dx.doi.org/10.1111/j.1748-720X.2010.00469.x
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.