Background
In the case, “Relational autonomy or undue pressure? Family’s role in medical decision-making,” a man referred to as Mr. M is in the intensive care unit due to respiratory failure. Mr. M specified to the healthcare team that he would not want any particular utilized to prolong his life. However, after speaking with his wife, Mr. M changed his mind. Since they were both immigrants who spoke a different language, the healthcare team did not know exactly what was said in their conversation. The doctor believed that Mr. M’s wife infringed upon his autonomy since he was competent at the time. This case therefore displays the worry some have regarding how involved families should be in adult patients’ medical decisions.
Dilemma
The main ethical dilemma involves whether a patient should make their own autonomous medical decisions or whether the family should play a role in helping the patient make a decision. Assuming the patient is competent, one viewpoint is that the patient should be responsible for deciding their course of action. Families may add pressure concerning their own interests or priorities, which may interfere with what is best for the patient. On the other hand, some feel that patients who are closely connected with their families may find it comforting and beneficial to discuss the situation with them. Together, they can review the options and come to a decision. In either case, the doctors should abide by what the patient determines.
Reflection
There are valid arguments for both sides of the dilemma. I feel the ultimate decision lies with the patient. However, in my opinion, family plays an important role in helping the patient make a decision. It is morally correct to assume that family is genuine in aiding their loved ones. Family support in these difficult times makes the patient feel that they are not alone. If the patient has a close relationship with their family and wants them involved, then the healthcare team should respect that decision. If the patient does not want the family to participate, then the patient should inform the doctor. Doctors sometimes believe that getting family involved may not be favorable. However, unless the patient expresses otherwise, the doctor should trust that the patient understands the situation. It should not be assumed that the family and patient will have a conflict, such as pressure from the family to come to a specific conclusion. Additionally, the doctor can communicate and discuss with the patient if the interest of the family is sincere. In doing so, the doctor can be comfortable as well. In the case of Mr. M, he had a cultural difference and possibly had trouble understanding the doctors and our culture. Therefore, Mr. M probably found it more comforting to discuss the circumstance with his wife. Even though he altered his decision after speaking with his wife, it appears that it was a sincere change of mind. As I reflect on this situation, I feel that Mr. M represents the many patients that prefer to have their family involved in their medical decisions. Thus, the healthcare team should respect when patients choose to do so.
Works Cited
Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Scandinavian Journal of Caring Sciences 22.1 (2008): 128-35. Web.
Image Sources
Patient-Centered Care: Giving Voice to Patients and Families
http://www.helpingyoucare.com/17013/nfca-calls-for-family-caregivers-to-help-support-the-center-for-medicare-and-medicaid-innovation-under-the-affordable-care-act
I definitely agree with the reflection part of your post. In this situation, Mr. M did not appear to believe that he was incapable of making the decision on his own and only changed his mind because of what his wife said. It would have been more reasonable for the physician to be skeptical if the patient had told him that the only reason he was switching his response was because his wife told him that he was not in a “competent state of mind” to make the DNR request. In that scenario, the physician could argue that the patient’s autonomy was being violated due to this coercion. However, in this case, it appears that Mr. M is making his own choice after consulting with his spouse, so it can be argued that his decision is autonomous.