For the case of Mr. M, he was a patient who suffered from a severe case of vasculitis. Mr. M presented into the intensive care unit with severe respiratory failure. Mr. M had a very poor prognosis and when his physician informed him of this and asked him about the course of action he wanted to take, he said that he did not want any extraordinary measures to be taken in order to preserve his life. Upon hearing this, however, Mrs. M was extremely upset and insisted on Mr. M changing his mind. As a result they had a discussion during which Mrs. M was visibly upset. They spoke in a foreign language so the physician did not know of what was being discussed. However, it seemed clear from body language and emotional gestures that the discussion was coercive. From that point on, Mr. M agreed to have extraordinary life-saving measures taken and Mrs. M directed much of the treatment decisions. This, of course, puts the physician in an uncomfortable position because Mr. M’s autonomy is being compromised (Ho 128).

The dilemma in this case is that Mr. M is losing his sense of autonomy in the current situation. Ho defends the need for autonomism by saying that the patient (in this case Mr. M) is the one who is most knowledgeable and most invested in his own personal state (Ho 129). In addition, Ho defines the implications of autonomism as being the “rejection of the image of patients as passive care recipients and the suspicion against manipulative and/or paternalistic influence anyone may have on patients’ decision-making process” (Ho 129).

While the implications listed are definitely important, unfortunately that does not always lead to the best outcome for the patient. In this case, it is debatable that having Mr. M’s wishes defied would even provide a better outcome, but there are cases where patients may feel as if they are without hope, but because of life-saving decisions from physicians, they were able to rehabilitate to a healthy state. For Mr. M, however, it seems that he knows his prognosis is poor and that he is only inflicting on himself more pain and suffering by continuing treatment.

Another issue I have with Ho’s definition of why an autonomous person should be able to make his own decisions. Her assertion is based on the assumption that the patient knows what is best for himself. However, this is not always the case. Physicians are trained to see patients go through incredible stages of depression and hopelessness. For the patient, however, when he or she is in that state of hopelessness and despair he can’t make decisions based on his well-being because he is too focused on his current pain and suffering. This might be the case for Mr. M.

In this case, it is hard to draw the line for how much Mrs. M can have a say in Mr. M’s decision. We can’t know of his future and how he will end up if he makes it out of the hospital and therefore it may be in his best interest to continue to receive treatment. However, in order to preserve his state of being an autonomous being, he does have to be able to make his own decision. I think the best course of action would be to ask Mrs. M to leave and for him to make his decision without her presence. Afterwards, should he decide to refuse extraordinary treatment, Mrs. M should be asked to stay out of his room until she can maturely accept his decision and understand his wishes.

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. 19 Feb. 2015.