The Golden Rule or empathy principle is the most familiar ethical imperative one comes across in everyday life. The rule states that one must treat others as oneself would want to be treated in a similar situation. The rule is easy to understand but it is not recommended to be used in a healthcare setting. This is because patients do not always want to be treated as a care provider would and ethical reasoning becomes indeterminate.
The Golden Rule Violates Patient Autonomy
Let us examine patient autonomy. As healthcare professionals, we must always respect the decision making process of the patient per the principle of autonomy. Our own cultural prejudices or personal preferences do not necessarily aline with those held by the patients of different cultures and mentalities.
A simple example is eye contact. I want someone to maintain direct eye contact when someone speaks to me, but there are many cultures where this to be rude. This is a simple example, but parallels can be made in common dental situations. The hygienist wants to educate while the patient wants to leave as fast as possible. The dentist may want the longest lasting restoration while the patient only values esthetics. We can think of many examples.
The golden rule as a solitary moral imperative rejects the wishes of the patient and introjects the provider’s own prejudices and preferences. We must consider the culture, history, and personality of the patient, not impose our desires over the patient’s deliberative process.
Using the Golden Rule can Lead to Indeterminate Answers
The Golden Rule also makes some ethical decisions indeterminate. Take for example an interaction between a masochist and a non-masochist. Following the Golden Rule, the masochist would decide that she should cause the other people pain because that is what she would want. The non-masochist would not want to cause pain because she does not want pain. The maxims “cause pain” and “do not cause pain” would both be willed as objective moral rules.
These two maxims logically contradict each other. So, we would not be able to say that both are moral laws everyone must universally follow. Otherwise, we would have to say that all moral agents should cause pain and also not cause pain. It is morally indeterminate which is the right maxim to follow when the Golden Rule is used. Using the Golden Rule to determine some moral laws leads to moral indeterminism.
As dental professionals, we must listen to the patient’s wants, personal experiences, and desires to create acceptable treatment plans and respect patient autonomy. The hope of following empathic principles is to pay attention to basic human values. The intention is that doctors have the same values as thier patients. The Golden Rule may serve as an idea to first consider.
However, we can impose our individual values on people from different cultures and perspectives merely following the Golden Rule. Is the doctor sometimes morally correct and are some cultural or personal values not worthy of respect? Yes, but if we interject our own values before listening to the other at all, this is denial of their deliberative process. In most situations, dental professionals can simply listen to the patient and make definitive moral decisions accordingly without the Golden Rule.