Background
In their discussion of understanding, Beauchamp and Childress present a case about a woman who was diagnosed with early stage cervical cancer while in the hospital for a hip injury. The woman refused to get treatment, and the doctors later learned that it was because she was in denial that she had cancer. The doctors questioned her competence to refuse treatment. Eventually, she was successfully convinced to consent to the treatment (Beauchamp and Childress 136).
Dilemma
Early stage cervical carcinoma is very treatable, and when the woman refused the treatment, her doctor was conflicted as to whether or not to treat her despite the refusal. The way the case was presented, it seems like as soon as the patient refused the procedure, the physician immediately concluded that she was not competent to make the decision, and the psychologists who analyzed her seemed to unfairly conclude that she was demented due to their own preconceived opinions. It was only after the patient was asked why she refused treatment when it became clear that her refusal was out of denial and ignorance, not due to dementia or mental incompetency; she did not think believe she actually had cancer because she felt fine (Beauchamp and Childress 136).
Ultimately, the principles at play are the patient’s autonomy versus the doctor’s commitment to non-maleficence towards the patient. The doctor has the patient’s best interests in mind and knows that the treatment is the best course of action in order to preserve the patient’s life. In his expertise, he knows that she has cancer and needs treatment, despite the absence of physical symptoms. In his view, non-maleficence might trump autonomy in this case, because even though the patient seems to have the mental capacity to make an informed decision, in his view, she is not doing so.
Reflection
It almost seemed like the doctors were too eager to mark the patient as mentally incompetent and proceed with the treatment. In a case where the patient is refusing what appears to be the obvious rational choice, I cannot blame health care providers for initially questioning her mental competence. However, rather than jump into conclusions, the first doctor should have communicated better with the patient and discovered the reason behind her refusal. That her denial of her condition was not revealed until after the neurologists were consulted suggests the many of the appropriate conversations did not take place between the treating physician and the patient.
While in many cases, it is not appropriate to try to persuade a patient deemed mentally competent that they have not made the right choice, in this case, it is clear that the patient was not making a fully informed choice (Beauchamp and Childress 136-7). In this case, it was definitely right for the doctors to intervene and undergo “intense and sometimes difficult discussions” with the patient to convince her to change her mind (Beauchamp and Childress 136).
If the patient was still not convinced she had cancer after having the truth explained simply but comprehensively multiple times by various physicians and family members, she might need another mental evaluation. I would assume that this time, she would be more likely (and rightly) to be deemed mentally incompetent, and therefore, non-maleficence would take precedence over patient autonomy. However, if after these discussions, the patient was fully aware of the treatment and of her condition and possible consequences and still did not want treatment, to further argue against or be otherwise unsupportive of her decision would be an unjustified violation of autonomy.
Works Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. 136-7. Print.
I think this case brings up some interesting questions about autonomy. Should a person’s decision be respected even if it is wrong? What does it mean to “respect autonomy”? I think there was some coercion in this case, but it is justifiable because it was in the best interest of the patient. Should patients be allowed to make bad decisions?
I think this case is a good example of how to best balance beneficence and autonomy. The doctor may have assumed to quickly that the patient was incompetent but, in my opinion, he took the correct steps in order to improve the patients autonomy. I’m sure as a doctor he has seen patients in denial before. He used his prior experience to help inform his choice to seek further help for this patient in regards to her competence. At the end of the day, she opened her mind and took in the information that was relevant other life. One question that we can think about is if she initially went into the hospital for a hip injury, did she consent to further testing? This further testing ultimately led to a diagnosis of cancer. The doctor also kept the moral principle of beneficence by telling her what he had found even though it was not related to the issue she had consented to treat. I think the doctor did the right thing because it provided her with an opportunity to be treated before the cancer could worsen but she may have not wanted the doctors to run further tests.
While the doctor could have handled the situation much better than just assuming incompetence in the patient, I think that in this case the ends justified the means. The doctor was doing his best to uphold the principle of beneficence, but there was definitely some coercion going on. But is that coercion acceptable in this case? If after further discussions with the patient in the appropriate environment (with family, counselors etc.), the patient still refused treatment, then I think the patients autonomy would have to respected, in spite of the potential cost it has to her health.