Case 1.1 handles the moral dilemma of who should decide whether or not Mrs. Francois should have the second surgery. Both the doctor and the patient’s family are in disagreement with the patient about her choice not to have the surgery. The family feels very strongly about Mrs. Francois having the surgery, whereas the doctor does not have the same emotional involvement, but feels that the surgery is the best medical decision for Mrs. Francois. This case deals with the moral issue of autonomy. As the patient on whom a medical intervention is being made, Mrs. Francois is legally granted full authority to decide whether or not to have the surgery. This case, however, questions many aspects of her decision.
As a precursor to an autonomous decision, the patient needs to be fully informed. The responsibility of this lies in Mrs. Francois’ doctor. As her doctor, he needs to adequately explain the surgery, as well as its potential risks and benefits. The case study does not provide details of what the surgeon said. The surgeon should take his responsibility a step further by also explaining other potential options to Mrs. Francois and their outcomes. He needs to not let his bias as a surgeon sway her towards surgery if there is another method available to her.
The doctor, however, still needs to make a recommendation. Medical recommendations inherently can be biased with doctors recommending prescriptions they commonly use, surgical methods they are used to, and methods of treatment they are most familiar with. This if not inherently bad, though, if their recommendations are most helpful to patients. It becomes as issue when financial biases are attached to their recommendations, which is why there are laws in place that require doctors to disclose medical practices in which they have a financial interest. In this case study, it would be incredibly wrong for Mrs. Francois’s doctor to recommend surgery if there was a better alternative, simply because he would earn more money from her insurance company from performing surgery. Recommendations are necessary because patients are in a vulnerable position because they do not have the same medical expertise as doctors. They need to rely on doctors to help them make decisions that are best for their health, which is why doctors need to give them a recommendation based on solely medical grounds.
After doctors make recommendations, they need to make sure patients understand the information they have disclosed and their recommendations. This element becomes much more ambiguous and difficult for a doctor to fulfill. In the case of Mrs. Francois, the doctor had difficulty knowing if Mrs. Francois fully understood the information given to her. While the doctor could be sure he told her everything he needed to tell and made a nonbiased recommendation, it was hard for him to be sure she fully understood everything. This was called into question because resisting the life-saving surgery seemed irrational and against her early behavior when she consented to the first surgery.
The overall issue in this case was whether or not Mrs. Francois was competent to make the decision. Because of all of the medical issues she has recently dealt with, her family argued that she was not competent, but the doctor felt she was because she could communicate in an intelligent manner. As the patient, the decision should ultimately be hers and the doctor needs to act in accordance with that. Because of the circumstances of Mrs. Francois’ health and her family’s disapproval, a third party should be brought in to judge her competence. The surgeon should receive a second opinion from a psychiatrist to judge whether or not Mrs. Francois is medically competent.
If the psychiatrist deems that Mrs. Francois is competent, then her decision to not have surgery should be honored. While the surgeon may be legally threatened by the son, this is not a reason for him to operate and he should stand by his decision to respect Mrs. Francois’ choice. If the psychiatrist feels Mrs. Francois is not competent, then the surgeon should honor the family’s wishes and perform the surgery. This could potentially save Mrs. Francois’ life and the surgery should not be forgone because she is temporarily mentally ill. In this situation, taking away Mrs. Francois’ autonomy to choose is the best choice because it can bring her the best outcome and reflect what she would have chosen if she was mentally competent.