When doctors should and should interfere is the basis of many bioethical questions. The wide range of scenarios that doctors face on a day to day basis, from whether or not they should force feed a patient to issuing a Do Not Resuscitate order, all share a common core that asks if the doctor should interfere or not. But what does it mean to interfere? Is interference anything that goes against the choice of the patient? But if the patient would benefit from the action is it interfering? Or is interference justified by the principle of beneficence? These questions, and many more are necessary in deciding what is the moral action in many bioethical decisions.
The Merriam-Webster dictionary defines interference as, “involvement in the activities and concerns of other people when your involvement is not wanted.” By this definition, any action taken by a health care professional that is not in agreement with the wishes of the patient is interference. So in order to respect a patient’s autonomy the physician must act according to what the patient wants and exercise no interference. However, the issue with this logic is that physicians, by the very nature of their profession, will encounter patients who do not want their involvement, but are not competent to make that choice. While every situation is different, Terrance Ackerman argues why doctors should intervene. He explains many reasons and justifications of when doctors should exercise their power and override the decision of the patient. While in the case of mental illnesses where competence and decision-making are compromised, I agree that decisions need to be made by a clear-thinking person, but I do not agree with many of the justification that Ackerman discusses.
One such discussion is surrounding fear. The article describes “fear as a cripple of patients to choose and make an autonomous choice.” It cites a story of a young man who refused neurosurgery because of the posiblity of neurologic damage who later died because of delayed treatment. I do understand that it must be difficult for physicians to see a patient refuse a life saving treatment, however ultimately it is their body, and they have the final decision if they are competent. Fear is a reaction to a person’s experiences and thoughts, which are difference for every individual and does not affect their competency. A competent individual should not be viewed as less autonomous because they have a differing opinion than a physician. Ackerman also quotes a phrase from The Healer’s Dilemma by Eric Cassell: “If I had to pick the aspect of illness that is most destructive to the sick, I would choose the loss of control. Maintaining control over ones self is so vital to all of us that one might see all of the other phenomena of illness as doing harm in their own right but doubly so as they reinforce the sick person perception that he is no longer in control.” If physicians abuse their power to override a competent patient’s autonomous decision because of fear, than physicians may lose the ability to override the decisions of patients who are not competent to make their own decisions and do need their assistance.
http://www.merriam-webster.com/dictionary/interference
Ackerman, Terrance “Why Doctors Should Intervene” The Hastings Center Report 12 (4): 14-17 (1982)
While I agree with the notion that there are situations where doctors should intervene, I find it hard to agree with your last comments on fear. I feel like you may be underestimating how powerful and controlling a person’s fear could be. It can make a rational person irrational, or a competent person incompetent. It can also bring up incongruences with a patient’s desires and decisions, such as in the case you brought up where the patient wanted to live but was too afraid to get the only surgery that could secure his life. We are emotional creatures, and emotions play an incredibly significant role on our decision making, so is it so farfetched to assume an individual with particularly strong emotions could be in fact clouded and be making decisions that don’t truly reflect her intentions or values?
I agree with you that emotions are not enough to simply deem a patient incompetent of maintaining autonomy, but I do feel that it has vast potential to impact a patients autonomous decisions, and should therefore be taken into high consideration by the doctor when determining how he will handle his patient.
While i do agree with the presumption extends that doctors hold the best interests of their patients at heart when making medical decisions. But even as we practice respect to autonomy, physicians are compelled by a stronger commitment to the ideal of beneficence, the welfare of our patient. In our role as patient advocates we override l autonomy when we suspect that the patients has earned his/her autonomy or neglect and when we strongly disagree with a doctors medical decisions. Because our purpose is more often to protect the patient more specifically in this situation, we have to support his/ her individuality I believe our commitment to advocacy is philosophically more consistent with traditional paternalism than the modern values of self-determinism and autonomy. We must offer Amelda the opportunity take control of her medical decisions not only by providing them with factual information but by assisting his/her in recognizing r personal values, by soliciting thoughts and answering questions. Rather than clashing or conspiring with the doctor as he uses his medical paternalism, we must help the patient to recognize the vital importance and healing effect of open communication with the patient, and the doctor should model respect and support as the patient begins to deal with the reality of their mortality. This is based on the idea that the patient is competent because if not its is my opinion that the doctors role become emphasized.
In your post, you discuss the topic of whether or not doctors should interfere in a patient’s medical decisions. However, I think it’s also important to understand the role that fear has in interfering in a patient’s decisions. If fear is an emotion that interferes in a patient’s ability to make reasonable decisions and judgments, then is the doctor even really “interfering?” You mention that The Merriam Webster Dictionary defines interference as the “involvement in the activities and concerns of other people when your involvement is not wanted”. If fear inhibits a patient’s ability to express their wants, then it could be that the doctor isn’t even interfering; rather, the doctor is simply treating.
I agree with your point, to some extent, that each person experiences fear in a different way and while it may affect the competency in some individuals, it may not affect the competency in another. However, how can a doctor really know whether or not fear has affected a patient’s decision-making? It can be difficult to assess whether or not fear has affected a patient’s decision-making. I would argue that if the risks of not interfering increase, then there should be more weight placed on the role fear may have on a patient’s decision-making capabilities. If the risks of not interfering are relatively low, the role of fear in the patient’s decision-making should not weighted very heavily.