(a) Citing the serious adverse effects of long-term medication, a doctor convinces the family of a female patient for surgery. This led the patient to reluctantly consent for the surgery, though her original choice was to opt for medication. Explain the concepts of paternalism and beneficence by analysing the doctor’s action. (b) Efficiency is doing things right, while effectiveness is doing the right thing. How do you strike a balance between the two to enhance productivity?
Approach · directive: “explain / how”
What it asks · (a) Use the doctor's persuasion to explain paternalism and beneficence and whether the patient's autonomy was respected; (b) explain how to balance efficiency and effectiveness to raise productivity.
The question has 2 parts — answer each
- (a) Explain paternalism and beneficence by analysing the doctor's action, and whether the patient's autonomy was respected
- (b) Explain how to strike a balance between efficiency and effectiveness so as to enhance productivity
Open with · (a) Beneficence is acting for another's good; paternalism is overriding their choice for their own good — the question is where persuasion ends and pressure begins.
Cover
- (a) Beneficence: the doctor wanted to spare the patient the long-term side effects of medication — a legitimate aim.
- (a) Paternalism: by persuading the family rather than the patient, the doctor moved the decision away from her; her consent was reluctant, not fully free.
- (a) Autonomy: Samira Kohli (2008) requires voluntary, informed consent from the competent patient herself; Mill: over her own body she is sovereign.
- (b) Efficiency without effectiveness wastes effort on the wrong goals; effectiveness without efficiency wastes resources.
- (b) Balance: outcomes first, then process (Aspirational Districts' 49 indicators); AIS rules demand efficiency, effectiveness and economy; Karmayogi's rules-to-roles shift.
- (b) Example: a health drive judged by people protected, not doses delivered; avoid target-chasing that distorts behaviour.
Close with · In medicine and administration alike, 'how' must serve 'what' and 'for whom'.
Add value (verified)
- Samira Kohli v. Prabha Manchanda (2008): valid consent requires a competent patient, voluntariness, and adequate information on the treatment. Samira Kohli vs Dr. Prabha Manchanda & Anr, Supreme Court, 16 January 2008 — Indian Kanoon ↗“the patient should have the capacity and competence to consent; his consent should be voluntary; and his consent should be on the basis of adequate information concerning the nature of the treatment procedure, so that he knows what is consenting to.”
- J. S. Mill, On Liberty (1859), ch. I: over his own body and mind, the individual is sovereign. On Liberty, Chapter I — John Stuart Mill (Project Gutenberg text) ↗“Over himself, over his own body and mind, the individual is sovereign.”
- All India Services (Conduct) Rules, 1968, Rule 3(2B)(iv): take decisions solely in public interest and use public resources efficiently, effectively and economically. All India Services (Conduct) Rules, 1968 (as amended) — Rule 3(2B), hosted by Tripura High Court (thc.nic.in) ↗“(iv) take decisions solely in public interest and use or cause to use public resources efficiently, effectively and economically;”
- NITI Aayog's Aspirational Districts Programme ranks districts monthly on incremental progress across 49 KPIs under five socio-economic themes. Aspirational Districts Programme — NITI Aayog ↗“measuring progress by ranking districts on a monthly basis. The ranking is based on the incremental progress made across 49 Key Performance Indicators (KPIs) under 5 broad socio-economic themes”
- Mission Karmayogi (Cabinet approval, 2 September 2020) supports a transition from 'rules based' to 'roles based' HR management, matching competencies to the post. Cabinet approves Mission Karmayogi (NPCSCB) — PIB, 2 September 2020 ↗“Supporting Transition from 'Rules based' to 'Roles based* HR Management.Aligning work allocation of civil servants by matching their competencies tothe requirements of the post.”
Question: UPSC's CS (Main) 2026, GS Paper IV — paper ↗. Approach: Minimalist IAS, checked 1 Oct 2026 (how we verify) — UPSC publishes no model answers. ·
Model answer · 382 words (UPSC limit 150) · Minimalist IAS
(a) Paternalism and beneficence in the doctor's action
Beneficence is the duty to act for the patient's good; paternalism is overriding or steering her choice for what another judges to be her good. The doctor had a sound aim but used a flawed method.
| Principle | Doctor's action | Verdict |
|---|---|---|
| Beneficence | Warned of drug side effects | Legitimate duty of care |
| Paternalism | Persuaded the family, not her | Choice steered, not respected |
| Autonomy | Consent given reluctantly | Not fully free |
- Beneficence rightly used: disclosing the serious long-term effects of medication was a duty; but beneficence decides what to offer, not who decides.
- Paternalism: convincing the family moved the decision away from the patient; a competent adult's informed preference was treated as an error to correct.
- Valid consent: in Samira Kohli (2008) the Supreme Court held that consent must be voluntary and based on adequate information; reluctant consent under family pressure fails that test.
- Gender lens: routing a woman's medical decision through her family reinforces an old denial of women's bodily autonomy.
- Mill's principle: "Over himself, over his own body and mind, the individual is sovereign." Her body, her decision.
Beneficence should shape the counselling; autonomy must decide the outcome.
(b) Balancing efficiency and effectiveness to enhance productivity
Doing the wrong things faster is not progress. The All India Services (Conduct) Rules require officers to use public resources "efficiently, effectively and economically": both are duties, not alternatives.
- Efficiency alone fails: files cleared fast on wrong priorities, roads to nowhere or toilets without water, waste effort in good order.
- Effectiveness alone fails: the right goal pursued with bloated cost and delay exhausts resources and reaches fewer people.
- Outcome first, then process: fix what change is sought and for whom, then optimise the route. NITI Aayog's Aspirational Districts Programme ranks districts monthly on progress across 49 indicators, judging results rather than spending.
- Outcomes over outputs: an immunisation drive is judged by children protected, not doses issued.
- Guard against target-chasing: quotas chased efficiently breed fake beneficiaries; independent evaluation and citizen feedback correct course.
- Roles over rules: Mission Karmayogi (2020) seeks a shift from "rules based" to "roles based" HR management, matching competencies to posts.
- Technology and delegation: automate routine work so that scarce attention goes to judgement.
Productivity rises when administrators ask "why" before "how", and then answer "how" with discipline.
Written by Minimalist IAS from facts checked at source (how we verify) — a little fuller than exam length, so every part of the question is covered; in the hall, keep the structure and trim the detail. UPSC publishes no model answers: compare your structure and coverage with this, then write your own.