In this week’s blog, I analyzed the reading discussing the idea of autonomy vs. pressure from family to make a decision about health. The case that I looked at was Mr. M’s. He was admitted into the intensive care unit because of respiratory issues. Initially he had told the doctor that he did not want anything extraordinary done regarding procedures that may resuscitate him. However, his wife intervened and said Mr. M needs anything that can be done to extend his life and Mr. M changed his mind about his initial decision after speaking to his wife. The doctor believed that Mr. M’s autonomy had been compromised and as a result this case looks at familial pressures on autonomy.
The main dilemma in this case has to deal with whether the patient deserves an autonomous decision or if familial help is necessary to make a decision. When facing tough decisions in a weakened state, a patient relies heavily on their support system (family) to help them through tough times. Doctors thus need to be able to identify if a patient is making an autonomous decision during their vulnerable state while maintaining respect for the patient’s full entourage.
While looking at both sides, I believe the doctor should prefer to take the patient’s autonomous choice into account when making clinical decisions. This statement is particularly true when a patient has full control over their mind and is able to make decisions for themselves. In today’s diverse world, there are many different types of support groups that patients surround themselves with which are outside of the standard family concept. Doctors must be able to abide the principle of non-maleficence when handling the patients by doing no harm. A doctor’s relationship with a patient has a holistic point to it and comes from both being respectful to the patient and their body. By respecting a patient’ s familial concerns while keeping the interest of the patient in mind, doctor’s can make a decision with respecting both the principle of autonomy and non-maleficence. In the case of Mr. M, I believe that the doctor should respect what he wants to do even if he suspects coercion by the wife.
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.
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I agree with you that the doctor needs to respect Mr. M’s decision, and not evaluate with too much suspicion if there were external factors. While Mr. M should make an autonomous decision, and that is what the doctor should be looking out for, most medical situations do include loved ones and support systems. If Mr. M explicitly states– in a competent state of mind– that he wants to take extreme measures to stay alive, then the doctor should respect that, since he was competent in his decision making. His wife is not a stranger, or unimportant factor of influence, thus it is natural that she could have an impact in his decision. But that is not for the doctor to heavily evaluate– his job is to respect what the patient says that he wants.
I somewhat agree with Ahyan, but what happens in cases where patients are autonomous , but making the wrong decision. We discussed a case in class where a woman refused a corrective surgery out of fear from a previous surgery. The patient would not give consent for the corrective surgery, but she would die without it. Her son said his mother was incompetent and basically gave consent for the corrective surgery. Here, familial influence was beneficial. Autonomous people do have the freedom to make the wrong decision, but i think that doctors have to think about the future outcome in order order to fully minimize harm. In some cases non-maleficience outweighs autonomy.
If the patients are autonomous and making the wrong decision then I feel that it is the doctor’s responsibility to convey the negativities associated with the decision. The example that you provide, while highlights the benefits of familial support, displays a patient that does not appear to be competent. In your example, I would agree with your finding because the patient does not show competence and thus does not appear to be able to make an informed decision. Doctors do have to think about the future but there are many elements that go into a patient’s decision to receive treatment. For example, the patient may have economical barriers that may influence their decision to neglect treatment or may want to attend an important affair that getting surgery would not allow them to go to. Patients are all different with many diverse priorities. For this reason, I believe that though doctors have to look to minimize the harm they also need to step up to the plate and be able to convince the patient to buy into their expert opinion. In today’s age, many patients feel like they know best because of the abundance of information on the internet. However, in my opinion, this technology driven era has given us an abundance of information but very little wisdom.
I agree with Ahyan that the course of action that the healthcare team is responsible to take is to respect Mr M’s wishes. Although his wife believes that everything should be done in order to extend his life, Mr. M’s initial decision declining resuscitative measures must be respected. Some would argue that Mr. M’s competence should be questioned. However, it is stated in the case that he was fully competent at the time of his decision. On a separate not, if it were the case that Mr. M assigned his wife to be his health care proxy (someone trusted to make health care decisions in the case that you lose the ability to make decisions yourself) then, I believe, the healthcare team would have the responsibility to respect her decisions.
https://www.health.ny.gov/professionals/patients/health_care_proxy/