Background
Mr. M is a patient afflicted with a vasculitis disease that has further compromised the integrity of his lung health. This brings him into the hospital where he at first informs his attending physician to forgo any treatments required to resuscitate him if he suddenly became unresponsive. This kind of request is known as a Do-Not-Resuscitate Order, or DNR. However, upon hearing this news, the wife persuades the patient to reconsider his DNR request and Mr. M consequently recants his previous statements. The attending doctor now is put into a situation where his patient’s right to self-determination and unobstructed autonomy has been impeded upon.
Dilemma
As noted by Ho in the article discussion entitled,”Relational autonomy or undue pressure? Family’s role in medical decision-making”, the most important aspect in the definition of self-determination is maintaining a free, unclouded, and not coersed selection to have.not, hav. Given this criteria, one draws the conclusion that there has been a clear violation of Mr. M’s autonomy since his desire for a DNR abruptly changed only after speaking with his wife. It also brings up the issue that were the patient to become unable to speak for himself, would his wife be a suitable candidate to act as his moral agent given their obviously different standpoints on necessary life-saving medical intervention?
Reflection
The most difficult aspect of this case is ultimately deciding whether the patient’s rights were infringed and to what extent has this right been violated. If the doctor concludes that the patient’s conversation with his wife singlehandedly led to the unnecessary and coersive change in is DNR request, the doctor will then not only need to find a way to speak privately with the patient again regarding his treatment but also make sure the patient is no longer allowed to be a lone with his family. Another issue that arises from this case is the idea of a moral agent and how they are assigned to cases. If someone like a spouse or parent, who is normally assigned as a moral agent for patients once they are deemed incapable of speaking for themselves, can have completely polarizing views to the patient’s, how can it be said that they are truly acting in the best interest of the patient? I believe that the conversation had by the patient with his wife was indeed coersive and gthat the doctor cannot merely overlook this change in opinion as a normal decision. However, if upon confrontation between the doctor and patient leads to the patient maintaining that they would like their DNR repealed, the doctor will need to abide by this new request. Ultimately, the coherent voiced opinion of a patient carries the weight necessary to allow a change of heart to be considered, likewise, valid.
Works Cited
1.) https://web-a-ebscohost-com.proxy.library.emory.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=92980486-cd52-4bae-90a4-7f0c98d75e4d%40sessionmgr4005&hid=4212
Death doesn’t happen to the deceased, it happens to those who are left behind. I do not understand why the doctor thought that the patient’s unobstructed autonomy has been impeded upon by his wife as he changed his mind about his DNR request after talking to her. She is the one who shares her life with the patient. She is the one who will take care of the patient and provide him with emotional support. She is the one who will be affected by his death the most. Respect for autonomy also includes respecting the individual’s ability to change his mind and discuss the matter with his family members. A patient might need reassurance from a family member that he/or she is there for him regardless of the consequences. The doctor might need to speak privately to the patient again to re-assure his free unclouded and non-coercive decision concerning his autonomy regarding DNR request. I do not think a doctor is allowed to prohibit the patient to be alone with his wife or discuss the DNR request with her.
I completely agree with you Lara. I do not understand how you can say that the wife’s actions were coercive. She wasn’t trying to coerce or deceive her husband into repealing the DNR, she was simply asking him to have it repealed because (most likely) she loves and cares for him so much. Lara hit it on the head when she said “death doesn’t happen to the deceased, it happens to those who are left behind,” the ones that have to watch someone they love and care about die but still have to continue on with their own lives are the ones most affected by death. It is not wrong for the wife to want to change her husband’s mind. This is her spouse, her lifelong partner, someone she has made a commitment to being with for the rest of her life. We aren’t talking about someone random that is purposely trying to deceive the patient, we are talking about Mr. M’s wife. Also, when respecting someone’s autonomy, you must take into account that they can and will change their minds, and that is someone that goes along with respecting an individual’s autonomy. I would like to say that yes, it would be a good idea for Mr. M’s doctor to talk to him in private in order to make sure that repealing the DNR is truly what he, himself wants and not just what other people want for him. But if Mr. M’s decision stands even after a private meeting then I do not believe the doctor has the right to think that Mr. M’s wife coerced him or that Mr. M’s decision is not his own.
This particular case epitomizes what Beauchamp and Childress express in the “Respect for Autonomy” chapter of Principles of Biomedical Ethics. Beauchamp and Childress write “The conditions under which an influence both controls person and lacks moral justification may be in clear in theory, but they are often unclear in concrete situations” (Beauchamp & Childress 140). This case with Mr. M. raises many different questions which are difficult to answer with the given information and background. I agree that the autonomous patient should be allowed to change his mind if desires. Mr. M’s decision to please his wife is a decision that he made, and to challenge this, can be argued as violating the principles of autonomy similar to the doctor’s claims that Mr. M’s wife’s influence was preventing him making autonomous decision. What if the patient values his family’s wishes, and would like to take it into consideration? Moreover, there are many individual persons who place the needs and wants of their loved ones before their own. To challenge this may make a person even feel uncomfortable or even guilty. While I do think it’s necessary to examine a patient’s autonomy, I do think it is important to evaluate whether a doctor that is “policing” to defend the autonomy of the patient by intervening between the family and the patient is causing more harm than beneficence.