Autonomy is one of the main moral principles. Beauchamp and Childress discuss how respecting autonomous agents involve acknowledging an individuals right to make choices and to take actions based on their values and beliefs. There are many elements that go into describing the principle of autonomy. The most present example of autonomy lies in the idea of informed consent.
Informed consent goes hand and hand with medicine these days. It is a concept that ties well with the principle of autonomy because it allows an individual an opportunity to satisfy the three condition theory (Beauchamp and Childress). In Principles of Biomedical Ethics, Beauchamp and Childress point out that there are three conditions that comprise the principle of autonomy. Choosers that display autonomy should act intentionally, with understanding, and without controlling influences that determine action. Intentional actions do not have to evoke a positive outcome; often times undesired outcomes are part of an intentional action. The point is to see that there was value in the decision made. In terms of understanding, an action should not be labeled as being autonomous if the individual does not adequately understand it. Poor understanding can be caused by absence of information and deficiencies in the communication process. Finally, a person should be free of both internal and external sources that my take away from an individual’s self determination.
There are various cases that can allude to informed consent. The major paradox in the American healthcare system is the criticism that doctors do too many tests/procedures. However, the reason for the quantity of tests may not be due to just simply profit as many capitalists might have you believe but rather the nature of our Judicial system. Throughout American history, there have been numerous examples of doctors being held liable for their patients.
An example case could involve a surgeon doing a simple biopsy on a patient. This biopsy will be performed with the doctor obtaining informed consent. However, during the surgery, the doctor discovers a threatening tumor. The ethics behind this situation are important because the doctor can either choose to leave the tumor or take it out. The patient would have already been induced into a coma so there would be no autonomy on the patient’s side to choose what they would want (Murray). The doctor is then left with the choice of taking out the tumor but not following informed consent or leaving it alone. The situation is tough because if the doctor does take the tumor out, he stands to be liable because the patient had not given him permission to take out the tumor.
In my opinion, I would leave the tumor in the body and not risk having a malpractice lawsuit aimed at me. The tumor could be taken care of at a later time when proper protocols have been met. My decision is driven mainly by autonomy concerns of the patient and I believe that their thought process on the matter is what matters most. Thus, we must support the patient.
Works Cited:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.
Murray, Peter M. “The History of Informed Consent.” The Iowa Orthopaedic Journal 10 (1990): 104–109. Print.
Ahyan,
I definitely agree that you should leave the malignant tumor in the patient’s body and wait to remove it at a later time upon consent from the patient. However, the idea of autonomy is quite foggy in the case on “Non-Consentual Electro-Convulsive Shock.” I believe that if the son was not in the picture, non-maleficence would overrule the patient’s autonomy, because who is to say that the patient is in a sound state of mind to make his own medical decisions. Supposedly, the patient, Simon, is competent, but perhaps he is so depressed that he is refusing treatment to hasten is death. However, because the son is involved, the doctor’s would also be going against the son’s wishes, who is competent and sound of mind. Therefore, in this case, I think non-maleficence outweighs autonomy. What do you think?
In terms of Simon, I believe that there is a very interesting dilemma presented to us. We have the option of giving him therapy or not giving him therapy. By keeping the principle of autonomy in mind, I feel that the doctor ought to put the patient in a position where he can make an autonomous decision. If that means doing the procedure then so be it because being able to get a patient to a point where they can be autonomous seems like course of action that I would take.
I believe that there are many factors that should be taken into account when making such an ethical decision of removing incidental findings of tumors in a surgery. First, it depends on what is indicated in the informed consent. For instance, a proactive doctor HAS to tell the patient that there will be a probability of incidental finding of more tumors or neoplasms that might need removal. Hence upon, a written consent of the removal of such incidental findings of tumors or neoplasms must be considered before the procedure; if the doctor gets a written consent, the removal of the tumor during the surgery is warranted; however, this is not the situation in this particular case. For that reason, I would agree that an incidental finding, under such circumstances, should be left alone and after closure and recovery, the proper protocol should be instituted prior to removal of the tumor. The surgeon cannot make a decision alone, though he knows what should be done to save the patient’s health, since it disregards the concept of patient’s autonomy. In the above case, many factors should be taken into consideration like the type of tumor, whether post-operative chemotherapy/radiotherapy is required, age of the patient, wishes of the patient, choice of palliative care, among others. Furthermore, the judicial system surely plays a crucial role in such ethical decisions making processes and physicians to be always acting in favor of preserving their license to practice, rather than patients’ benefit. Ethically, is this something right to do?
Regarding the surgeon, he was acting on the spot and did not have time to consult others because of the nature of the surgery. He was simply in there to do a biopsy and discovered the malignant tumor. I do feel like there is a sense of autonomy that has to be played in this situation because its the patients body. If anything, the doctor could easily be charged with battery in this situation. I agree that more time should be taken to understand the patients health before going in but when encountering an unexpected dilemma like the one with the surgeon, the cost of saving a life seems to be in the moral code of that doctor.