How big of a role should our family play in our lives? Obviously, family members are significant others who have and will influence us in every aspect of our lives. However, when it comes down to making medical decisions, I believe that family members’ opinions should be carefully and critically evaluated. When patient’s autonomous decision clashes with those of family members, doctors should be able to follow the decision of the patients while respectfully letting go of what family members have to say and have decided.
Consider Mr. M who reversed his decision regarding resuscitation and other life-extending measures after talking with his wife (1). Mr. M is totally autonomous. He was fully conscious and was aware of what he was going to encounter; in other words, he was competent because he had the abilities to comprehend, process information, and reason about consequences of his actions, which we can somewhat assume from what is told from the short scenario (2). Therefore, there is no reason for considering his family member’s opinion at all. It may sound harsh, but here is my question: can we say it is moral for a person to defer his autonomy to another person when he is competent? This is completely different scenario from one giving informed consent to doctors to perform a surgery. In the latter case, there are voluntary, understanding, and authorizing actions that rise from one’s autonomy, while in the former case one is completely giving up his or her autonomy. Family members are very important involved in decision-making, but the final say should go to the patient who is competent.
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One general belief of relationship between family members is that they aren’t based on temporary contracts but on empathy and beneficence family members have towards one another (1). This argument can be used to defend the view that family members have a say when making a medical-related decision. There is nothing wrong with this statement itself, but the interpretation of the meanings of empathy and beneficence may become problematic. For instance, one Jehovah’s Witness family member in the Well and Good would not support blood transfusion thinking that it will ruin one’s soul and ultimately turn into dust after death instead of being saved to enjoy the eternal life with God. However, there is the patient who is not as devout of a believer pleading to doctors to save her life (3). There are many issues to consider, but I would like to briefly focus on one of them here whether we can consider the family member’s point of view as beneficence.
The Jehovah’s Witness family member who doesn’t support blood transfusion holds irrational belief that prevents him from grasping true belief, which would allow him to have a reasonable argument to deny the surgery with blood transfusion if he had one. Doctors should be hesitant to respect his choice for his daughter because his opinion isn’t reasoned from a true belief and thereby is not rational (4). True belief comes from understanding the contextual information and applying those information to set one’s goal. The father believes that he is doing what is the best for his daughter by not giving blood transfusion and saving her soul, but since it’s based upon a false, irrational belief, it is a false beneficence that would actually harm and kill his daughter. I think it is important to realize that empathy and beneficence are what give family members a say to what the patient goes through in the hospital setting; nevertheless, it is also crucial to consider where the beliefs of the family members are coming from.
Generally, family members seek the best option for the patient, but doctors should still respect patient’s autonomy over the family’s input in patient’s decision because the values the family members hold may not necessarily correlate with what patients hold. Better yet, doctors need to be careful and put more weight on patients’ autonomy; family members’ views might not always be based off of a true belief, as it wasn’t in the Jehovah’s Witness case.
References:
- Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Nordic College of Caring Science (2008): 128-35. Print.
- Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 117-40. Print.
- Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.5 Religious Conflict over a Life-Saving Blood Transfusion.” Well and Good: A Case Study Approach to Health Care Ethics. N.p.: n.p., n.d. 142-50. Print.
- Savulescu, J., and R. W. Momeyer. “Should Informed Consent Be Based on Rational Beliefs?” Journal of Medical Ethics 23.5 (1997): 282-88. Web.
I agree that doctors should respect a patients’s autonomy over the family’s input, especially when the patient is deemed competent. However, I would challenge your beginning statement: “Obviously, family members are significant others who have and will influence us in every aspect of our lives.” While this is true for many families, I think it is equally untrue for many others. There are many instances in which family members are absent, incompetent themselves, or have vastly different views as the patient – as you mentioned in your blog. I think putting autonomy in the family’s hands also raises the question of who in the family makes the decision. In the Jehovah’s Witness case, the parents had differing views. But what about a cases in which a spouse has vastly different views from the parents?
Although I do not personally believe that blood transfusions can condemn one’s soul, I think we must consider and respect others’ religious beliefs in the health profession to protect the well being of all patients. It is important that we do not solely view the concepts of health and illness from a biomedical perspective and recognize that health and illness are value laden and culturally constructed. The constitution of the WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” In the case of a Jehovah’s witness, it is important to note that performing a blood transfusion will not only cause mental and spiritual distress, but potentially social as well (if they are to be kicked out from the church and looked down upon by fellow practitioners). Although I agree that doing the blood transfusion would minimize physical harm, there are other types of harm that need to be considered.