Introduction
For many people family is important part of their life. That includes when they need medical care. These are the people who are often appointed medical proxies and moral agents. However if they are not fulfilling these allotted roles there place in the care situation may be ambiguous. Who exactly counts as family? What moral effects can the family have on the patient?
Discussion of First Problem
The first issue is who counts as family. For insurance provides the issue is as simple as a person, their spouse if they have one, and any underage children they have. For the children it includes only their parents or any adult relative they live with. However there are always tricky issues. Consider a same-sex couple that has been together for a long period of time, but reside in a state that does not allow marriage. Many people would argue that despite their lack of an official marriage document their spouse has every right to the normal entitlements of a family member. There could also be many cases where the family is in fact not the individuals closest to the patient. An estranged sibling for example may not want his or her family present or given any rights in a medical scenario. There would also be cases where the family unit extends well beyond the nuclear family. Do aunts and uncles and cousins and grandparents have right in a healthcare practice? American as a whole tends to be an individually focused society. Other cultures place a significantly higher importance on family and the patient may view themselves as nothing more than a part of the family unit. The term family is excessively contacted and could feasibly be replaced with a tern like authorized patient relation, which would include the individuals decided on by the patient. This entire convoluted mess could usually only be solved by the directive of the patient, which not always an option in an emergency scenario.
Discussion of Second Problem
The identification of the authorized patient relations aside, there is then the issue of what rights they are given. Foremost among these with the assumption of competent patients is information. The patient’s loved ones are often desperate for information about the condition. Hospitals have waiting rooms for these people to be waiting on this information for a reason. Anyone who the patient has brought with them or who has brought the patient in likely has a desire and a right to information about the patient’s condition. However, if possible this should be all with the patients consent. There may be details the patients wish to have withheld or persons the wish to be excluded from the information. The authorized patient relations also have the right to see and speak to the patient if that is medically advisable. However the paramount value to observe in these situations is the autonomy of the patient. There wishes should be maintained if at all possible. Final decisions should be made in private to avoid familial influence and the advance directives of the patient are to be followed even against the wishes of the family. The exceptions are of course cases in which the competence of the patient is in question. In these cases the role of the family is elevated to the primary decision maker and the assumption of the responsibility for the patient.
Conclusion
A patient in a hospital is never just a patient. Each patient comes with their own accompaniment of people who love them, or don’t and baggage. There can and never will be a universal set of guidelines for every case to govern the rights of the family. The healthcare professional will always have to make some judgmental calls, but if they hold the autonomy of competent patients as the primary objective both in terms of who can and can’t be defined as family and what those people can do, the vast majority of issues should be prevented.
References
Definition of family from:
http://www.shadac.org/files/shadac/publications/SHADAC_Brief27.pdf
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.
I understand that any patient’s autonomy should be respected, and this is the reason that sometimes family members may not be participating in a medical-related decision making. However, when you mentioned that “There may be details the patients wish to have withheld or persons the wish to be excluded from the information,” one question came into my mind: usually don’t doctors tell patients’ family members about the conditions of the patient rather than telling the information directly to the patient? I wish you were a little bit clearer here with an example, perhaps, but I personally advocate the view that the information should be delivered to the family members first, if not together with the patient. This is because I believe that non-maleficence is important. Considering the fact that the patient’s health conditions may deteriorate due to the information if it were shocking, it can be actually one of the moral responsibilities of doctors to tell the family members first before disclosing the information to the patient. In addition, when you stated, “Final decisions should be made in private to avoid familial influence and the advance directives of the patient are to be followed even against the wishes of the family,” I agree with you on the perspective that the patient’s autonomy should be respected, and the decision can be made against the wishes of the family members. However, I don’t think it should be made in private without influences of the family members. In her article, Ho brought a feminist view point that a patient may view the welfare of loved ones more significant than the interests of any individual self in isolation (1). Because most patients, if not all, love their family members, it is important to them what their significant others think. Again, I do agree with you that the decision should be made autonomously without any coercion or manipulation, but I believe that family members should be still part of the decision-making process.
Reference:
1. 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.