Autonomy, individualism and suspicions of family involvement
Anito Ho defines the self as being an autonomous entity non-influenced by others. One of the main goals of bioethics seeks to make sure that the patient is treated as an autonomous being and that doctors are honoring the rights of patient autonomy in that the patient makes their own decisions about the health care they will receive. Once given their prognosis, and once believed competent enough to make a rational decision of what should be done going forward with treatment, the patient should be able to decide what they feel is best for them. However, patient autonomy becomes compromised when family members of the patients seem to suede the decision making of the patient that ultimately violates patient autonomy. What role should family members play in the decision making in treatment? Ho goes on to state that the role of the family member is “helping the patient to endure the healthcare experience, relaying patient information to clinicians or providing long- term care once the patient returns home. In other words, family members are seen mostly as a means to the patient’s clinical ends (Ho, 2008)”. I believe this to be true, family members should be there for emotional support for the patient as well so to provide physicians with any information that they may need. They should not interfere with the decision making of the competent patient. Families should only intervene at the expense of the patient only if the patient seeks advice from their family. Sometimes patients and their family disagree and because of fear, the patient will succumb to the wishes of their family members such as in the case with Mr. M.
Patient-hood and institutional medicine: how family and relational identity help preserve patients’ agency
In contrast, Ho further argues that with patients who come from close knit family units would actually benefit from conversing with their family about their treatment. Forcing patients to decide what to do with their treatment, while they may already not be in the right frame of mind to make a decision and under a lot stress because of the emotional state that they are in with their illness, may “leave patients feeling overwhelmed in fending for themselves, and families being left out in the patients’ journey” (Ho, 2008). As an adult, and one who values the opinions of my family, I would want the option to seek counseling and advice from my immediate family members. Getting input from family members may not be all that detrimental. The patient is still being autonomous in a sense.
Conclusion
Patient autonomy should certainly always be valued and familial input should not be shunned. The only time familial input should be seen as undermining patient autonomy is when it is blatantly obvious that a patient seems conflicted between their own desires and the desires of the patients’ family. At this point, the doctor should distance the family from the patient and allow the patient to think clearly without any distractions and outside influences.
Works Cited
Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Scandinavian Journal of Caring Sciences22.1 (2008): 128-135.
This is a great summary of Anita Ho’s Essay. One thought I had that extends beyond the essay has to do with after separating a patient from their family in order to promote a competent patient’s autonomy. I think the health professionals or someone in their office should also have a meeting with the family once the patient has made their decision. A huge part of health has to do with recovery. If a patient decides, against their family’s suggestions, to have a procedure then the family needs to respect that decision. If the patient returned home and the family is still upset at the patient for having the surgery then they may be living in a very hostile environment. Support is key for recovery and the family should be briefed on how best to care for their loved one even if they did not agree with their decision.
Yes, I definitely agree that the family’s input should not be dismissed in every case. As healthcare moves towards patient-centered care by establishing the importance of autonomy, questions about the role of family are brought into question. I would argue that to assume without any real knowledge how a patient is evaluating the family’s wishes is contradicting the core tenets of “patient-centered” care. In a scholarly article published in the “Journal of Healthcare Risk Management”, the authors write that patient-centered considers the patient’s “cultural traditions, personal preference, values, family situations, and lifestyles” (Sine & Sharp 32). In increasingly diverse healthcare settings, it’s especially important to consider the wide ranges of cultural traditions, and how those traditions may impact the way patient’s may act in healthcare settings. Similar to what you expressed in your posting, there are some individuals that come from cultures where it is important to consult with family members with major life decisions. Moreover, I do think that many of these questions about relational autonomy and the role of family in a patient’s medical decisions is better understood when the patient and the doctor have a well-developed relationship. In class, we discussed how when the patient and the doctor have established a relationship over a long period of time, the doctor has a better understanding of the patient’s character as well as the patient’s family.
Work Cited:
Sine, David M., and Virginia A. Sharpe. “Ethics, risk, and patient‐centered care: How collaboration between clinical ethicists and risk management leads to respectful patient care.” Journal of Healthcare Risk Management 31.1 (2011): 32-37.
Mekdes, I agree with you that when the doctor and the patient have a long-term relationship, there is a better understanding of familial relationships between the patient and his or her family. However, what happens when this close doctor-patient relationship is not feasible? Many people are not afforded the opportunity to build lasting relationships with their primary care physicians. This is why patient-centered care is important in that the patient’s holistic development is taken into account and their cultural views is being used as a marker in a way to assess how doctor’s should go about treating their patient. Patient-centered care should be universalized in that the doctor should be able to assess familial ties in every situation just by asking a survey of questions.