3.4.1 Practitioners know intuitively what it means to act ethically
Many health practitioners claim they have never encountered an ethical dilemma during their practice. Is this credible, or does it suggest that some practitioners have an insufficiently developed awareness about what constitutes an ethical issue? How many people justify a hard decision simply by saying, ‘I did what felt right'? Gut instinct may currently guide practitioners through some of the complexities of therapeutic relationships, but this is not an adequate substitute for rigorous, reflective analysis of the ethical basis of the therapeutic encounter. Ethical deliberation attempts to make ethical decision making an explicit process, which can be externally evaluated, rather than relying on the intuitive or subjective views of practitioners. This is important because the practitioner's internal morality may be at odds with the user's values and wishes (for example, about abortion, recreational drug use, sexuality and lifestyle choices, or CAM therapies).
Paternalism arises when practitioners feel they know better than the users and impose their own views and values on the users. While there may be limited scope for benevolent paternalism within long-established caring relationships, many users state ‘dissatisfaction with medical paternalism’ as a reason for bypassing their doctor and choosing to see a CAM practitioner, precisely because they value being treated like equal partners in a therapeutic enterprise.