Blog 1: When Physician’s and Family Disagree
Dilemma: In the case of Mrs. François there is a dilemma to operate or not to operate. If the doctor operates, it seems that the patient’s autonomy is violated because she has clearly expressed that she does not want to have surgery. On the other hand, the doctor has an obligation to do what is best for the patient, and if he does not operate Mrs. François will die. I believe the doctor can operate without violating the principle of autonomy. First, we have to determine what the patient’s choice is because she has made more than one decision. Mrs. François has made the following 2 conflicting choices: to have surgery in order to live, and to not have surgery and die. Which choice accurately represents the patient?
Personal Opinion: I will argue that the doctor should operate on the patient, and that this action does not violate the patient’s autonomy. I believe the doctor should operate based upon the principle of autonomy, under the following specification: respect choices that accurately represent the desires of the patient. Mrs. François initial choice to have surgery on her ovaries shows that she values her own life and wants to live. I think that the side effects of the hysterectomy and bilateral oophorectomy have created a fear in the patient that undermines her competence. She rightfully has a fear of having another operation because the first operation got her into her current situation. The doctors have tried to explain to Mrs. François that her situation is life-threatening and she needs surgery in order to live; but I think Mrs. François is not competent enough to understand due to her fear. I believe that Mrs. François does not want to have surgery because she does not want to die. She wants to live. She feels better and is most likely afraid to go under the knife again due to the outcomes of her previous surgery. Therefore, she does not agree to have another surgery because she feels fine, and probably does not trust the doctors to have her best interest in mind. The case states that, “respect for the autonomy of individuals does not require respecting their expressed wishes if these can be shown to be seriously out of character and irrational” (66). Assuming that Mrs. François wants to live, then her choice to not have surgery is out of character. Also, the son has expressed that his mother is not acting like herself, and that she does not fully understand the consequences of her choice. Therefore, I believe that the doctor ought to operate with the consent of the son because Mrs. François is acting out of character. The patient’s decision is made out of fear rather than her true desires.
Comparison: This case is very similar to Mr. Z case. Mr. Z was severely depressed to the point of suicide, but refused electroshock therapy. His son also refused to consent to him having the treatment. In class, we questioned when we should respect one’s autonomy. We concluded that we should respect autonomy when it does not harm the individual. In both of these cases, the principle of autonomy and non-benevolence overlap. Through specification and balancing, it is possible for these principles to intertwine and produce the best outcome.
References
Thomas, John E., and Wilfrid J. Waluchow. “Case 1:1 When Physicians and Family Disagree”. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.
Thomas, John E., and Wilfrid J. Waluchow. “Case 6:1 Non-Consensual Electro-Convulsive Shock Therapy”. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.
I would say that I agree with the “Personal Opinion” part of your blog entry. I would also like to add that the patient’s potential lack of trust in the surgical team that would be doing the second surgery plays an important role. The case mentions that those original physicians made a mistake during the first procedure: “The sigmoid colon injury was a laceration in the bowel, which was oversewn. The patient was put on antibiotics post-operatively” (Thomas, 71). Therefore, she may not be comfortable with those same physicians performing the second operation. I believe that she very well would have been more open to the second surgery if she knew that a different surgeon was operating on her.
Reference:
Thomas, John E., and Wilfrid J. Waluchow. “Case 1:1 When Physicians and Family Disagree”. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.
I also agree with Dmitriy and support your personal opinion as well. I would like to specifically address your statement of “Mrs. François is not competent enough to understand due to her fear.” I agree with you here but believe there is a way to make that argument stronger. At first, Mrs. François agreed to have surgery done, a decision made with her being in a completely rational state of mind. Now when she later objects to have a second surgery done, the conditions in which she changes her mind and her literal state of mind are far different than they were initially, and I believe this is a very important distinction to consider. After the first surgery, she is in pain and left with a huge sense of distrust for her original physician staff. She wants nothing else but to NOT have a second procedure done. But this change of mind has to be questioned due to her physical and emotional state of well being, both of which are at a far worse place than they were when she made her initial decision of having surgery. There are too many external factors in order to be able to trust that her new decision is entirely rational and is the best decision for her. Her change of mind is based on her emotional instability, due to a loss of trust for her physician staff, and her physical deterioration, which seems to be worse than it was when the entire process initially began. Therefore, while it is acceptable for people to change their mind on whatever they please, I do believe that for someone to change their mind they must be in the same physical and emotional state before and after the new decision.