Dr. Anita Ho’s article, “Relational autonomy or undue pressure? Family’s role in medical decision-making,” urges physicians and healthcare professionals to promote understanding and support between patients and their families regarding serious medical decisions. Some see a family’s influence as a violation of a competent individual’s ability to make an autonomous choice about their health, and some see it as irresponsible on behalf of the doctor to allow a family to do so. I would argue, however, that a family’s presence and influence in a patient’s decision is an important if not critical aspect of their own autonomy and that it should not be viewed always as a detrimental aspect to the decision-process, but a helpful one.
In her article, Dr. Ho states “Contemporary medicine has inadvertently reduced many patients with full histories and relational identities to diseased body parts and medical jargons” (Ho 130) to introduce the impact that advancing medical care has on a patient’s experience. While advances in technology and more complex procedures are fantastic and life-saving, at times a patient feels small and helpless in the process. If doctors neglect to fully explain situations and terms to patients, there is a risk of manipulation or detachment of the patient from the issue at hand. The presence of a family’s questions and opinions in cases like these, as Ho mentions, can reduce confusion and allow the patient a sense of security. A physician must certainly balance a family’s opinions as well as those of the patient on a case-by-case basis.
A family can sometimes aid in advising what professionals believe is medically best for the patient, but can also provide a patient assurance in what medical professionals perceive as the medically wrong decision. In the W&G Case 3.2 concerning Simon and the administration of electroconvulsive shock therapy, Simon’s son was present and supported his father’s decision to not undergo the treatment. There are other aspects of autonomy and consent present in this case, but in the familial sense, Simon’s son was present, listened to medical advice, and supported Simon’s decision. The support Simon’s son offered did not necessarily sway Simon’s decision but still provided influence in it.
In an article by Dr. Laura Sedig published by the AMA Journal of Ethics, it is argued that “Focusing on the strict definition of autonomy and failing to recognize an individual as part of a family leads to an incomplete understanding of decision making for informed consent” (AMA Journal of Ethics). Neglecting to involve a family in a serious medical decision does just that – creates a platform of misunderstanding and a risk of uninformed consent on behalf of the patient. A holistic approach to medicine does not just include the physiological or mental components of a case, but the entire picture. The impact of a patient’s relationships and understanding are paramount in ensuring the best medical decision is made. Families’ opinions truly can influence a patient to the point where they completely change their mind about what they want. A concept of autonomy is that “beliefs and choices shift over time,” (Beauchamp and Childress 113), so is ignoring a family’s ability to do this a risk to a patient’s own autonomy?
Works Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009, 2013. Print.
Ho, Anita. “Relational Autonomy Or Undue Pressure? Family’S Role In Medical Decision-Making.” Scandinavian Journal Of Caring Sciences 22.1 (2008): 128-135. Psychology and Behavioral Sciences Collection. Web. 12 Feb. 2017.
Sedig, Laura, MD. “What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree?, Jan 16 – AMA Journal of Ethics (formerly Virtual Mentor).” AMA Journal of Ethics. American Medical Association, 2016. Web. 12 Feb. 2017. <http://journalofethics.ama-assn.org/2016/01/ecas2-1601.html>.
Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.2: Non-Consensual Electroconvulsive Shock Therapy.” Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. 124-31. Print.
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Peter C. Vey/The New Yorker Collection/The Cartoon Bank
(from: http://blogs.hospitalmedicine.org/Blog/the-return-of-the-death-panel/)
Hey Elisabeth!
I agree with your argument in that a family’s presence is a vital part in a patient’s decision for treatment, however you have to be careful of instances where family members are overly persuasive, manipulative or even coercive. In Dr. Anita Ho’s article, “Relational autonomy or undue pressure? Family’s role in medical decision-making,” she discusses the case of Mr. M. Mr. M is suffering from a severe vasculitis disease and experiencing respiratory failure and explains how he does not want “anything extraordinary” done (Ho, 2008). However, his wife takes over the situation in planning his medical decisions and Mr. M reverses his original treatment requests. Normally, I think that family members should be included in the decision making process or at least get to hear the possible options, but Mr. M’s wife has overstepped by manipulating or possibly even coercing her husband to change his mind, we do not know the exact circumstances. In a situation like this, I think it is important for the physician to step up and regain control of the situation, whether that means talking to Mr. M privately and really trying to understand the sudden change of heart or speaking with his wife and addressing the importance of Mr. M’s right to make a decision about his own treatment.
Works Cited:
Ho, Anita. “Relational Autonomy Or Undue Pressure? Family’s Role In Medical Decision-Making.” Scandinavian Journal Of Caring Sciences 22.1 (2008): 128-135. Psychology and Behavioral Sciences Collection. Web. 15 Feb. 2017.
Hi Rylee,
I agree — a physician must balance the situation between a patient and family. Since you mentioned that the physician must “regain control” of the situation, I’m curious as to at what point you think a situation gets out of hand. In Mr. M’s case, I don’t think it was out of control by any means, but I’m assuming there are situations that occur in which they do. How would a physician “regain control” if this happened?
Thank you!
Elisabeth Crusey
Elisabeth,
I really enjoyed your blog post and I thought the way you incorporated Simon’s case into your explanation made it even more thorough. I agree with your argument that a family’s opinion is an important voice to be heard when a patient is making a decision on behalf of their health. Not only does the patient’s decision ultimately affect them, but it also affects their family because “there is no way to detach the lives of patients from the lives of those who are close to them” (Hardwig).
In the article “What About the Family? – the Role of Family Interests in Medical Decision Making,” Hardwig argues that “to be part of a family is to be morally required to make decisions on the basis of thinking about what is best for all concerned, not simply what is best for yourself” (Hardwig). However, I disagree with this statement. While I think it is important for a patient to take into consideration how their decision in regards to treatment will affect those close to them, I do not think that the impact of the patient’s decision on others should drastically impact the patient’s thoughts. I think that including the patient’s family in medical discussions pertaining to the future health of the patient is important, but I think it should be monitored to make sure that the patient is able to make an autonomous decision that is truly in their best interest.
In your blog post you mention that “a family can sometimes aid in advising what professionals believe is medically best for the patient,” but do you think that it is possible for a family member to overstep and coerce the patient into making a decision they are not comfortable with? How would you suggest that a physician facilitate this situation so that it does not diminish the patient’s autonomy?
Morgan Brandewie
Works Cited:
Hardwig, John. “What About the Family? – the Role of Family Interests in Medical Decision Making.” What About the Family? – the Role of Family Interests in Medical Decision Making. N.p., 20 Mar. 1990. Web. 15 Feb. 2017.
Hi Morgan,
Thanks for your comments! I definitely think that a family member can “overstep and coerce a patient into making a decision they’re not comfortable with.” This is possible in all aspects, and especially when emotions run high and people are not at their best state of mind, patients and family. I’d imagine that a physician could best mediate this situation by first, trying to understand the patient at hand through the eyes of the family. A family can often give critical health history information and other points important to an issue and subsequent treatment plan. In terms of coercion on behalf of the patient, a physician must inform in an unbiased manner the patient and family. Below is the link to a cite that defines a little more the relationship and duties of families and physicians. To prevent abusive or coercive situations physicians can also look for abuse within the family, such as dominance of one person in a relationship or signs of physical abuse. There is a delicate balance in order to do what is best for the family while keeping in mind the family and a physician’s duties.
http://www.aafp.org/afp/2011/1001/p780.html
Thanks!
Elisabeth Crusey
Citation
Folashade S. Omole, MD; Charles M. Sow, MD, MSCR; Edith Fresh, PhD; Dolapo Babalola, MD; and Harry Strothers III, MD, MMM, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia. “Interacting with Patients’ Family Members During the Office Visit.” Interacting with Patients’ Family Members During the Office Visit – American Family Physician. American Academy of Family Physicians, 2011. Web. 19 Feb. 2017.