In case 5.1, a 22-year-old mother goes into premature labor and delivers a baby in need of “aggressive resuscitation” (Thomas, et al. 186). With rapid deterioration after only the first 12 hours of life, the baby has a poor chance of survival and high risks of suffering from cognitive disabilities even if she does make it. Someone must now decide whether or not to withdraw the use of the ventilator, but with the parents in somewhat of a disagreement, who gets the final say and what might affect that decision?
There are many dilemmas at play here and I recognize that the principle of nonmaleficence plays an important role in this case as do the distinctions and rules governing nontreatment addressed by Beauchamp and Childress, but in this discussion I want to focus on the interactions between the parents and the health care professionals. I find the resident’s statement – “I certainly wouldn’t like to grow up as a cognitively disabled, visually impaired child” – to be completely inappropriate and unprofessional (Thomas, et al. 187). Respecting a patient’s autonomy or even a surrogate’s decision in this case, means letting a patient or surrogate choose. These difficult evaluations require us to analyze our values. Physicians should not recommend values, but rather, provide the facts relevant to the situation. While others may argue that you seek out your health care professional for advice in times of need, I believe that the resident should not reflect his personal beliefs and values about the meaning of life or limitations of the cognitively disabled, especially since he has no personal experience as a disabled person. A review of ethical issues involving premature births even agrees by stating that “physicians should be careful to separate their personal views…from current medical, legal, and moral standards of care for such children” (Baer & Nelson, 2007). Premature birth and the decisions to treat or not treat that accompany it contain this messy gray area.
In a journal discussion by Rebecca C. Thilo, she examines ethical issues in relation to the distribution of emergency contraception. In one section, she addresses the attitudes and beliefs of nurses who provide emergency contraception to adolescents, who express personal disapproval of such methods and choices. She explains how “it is ethically unacceptable for health care professionals to penalize patients for their actions” (Thilo, 2012). Despite the difference in topic, the social judgment the resident expresses can affect and bias the parent’s decision as does a nurse’s critical and disapproving lecture on the uses of emergency contraception. In both situations, the nurse and resident should not be expressing their personal beliefs or values in order to respect and maintain patient autonomy. It is the responsibility of the health care professional to present the facts of the treatments and different options available to the patient without immediate personal input. The resident should not provide personal input, but simply explain the important facts clearly so that the parents make an informed and autonomous decision without influence or judgement from the healthcare professionals around them.
Works Cited:
Thomas, John E, et al. “Case 5.1: Should Treatment Be Withheld from Patients with Severe Cognitive Disabilities?” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.
Baer, Gerri, and Robert Nelson. “A Review of Ethical Issues Involved in Premature Birth.” Rev. of Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. (2007): n. pag. NCBI. Web.
Thilo, Rebecca. “Barriers and Biases: Ethical Considerations for Providing Emergency Contraception to Adolescents in the Emergency Department.” Virtual Mentor 14.2 (2012): 121-25. AMA Journal of Ethics. Web
Good post!
One of the things that really made me think and question the resident’s statement was the tone and the way in which it was presented to the patient. The resident seemed to have a negative view of the patient’s thought process and was only looking at things from their own perspective. This led to me thinking about the difference between what is considered advice vs. opinion. What the resident stated was closer to an opinion rather than advice, because it was not based in prior experience, and had an emotional element attached to it. However, medical advice would be closer to what the pediatrician said, by providing factual evidence on the probability of becoming disabled or coming out of the situation healthy.
Citation:
Corbett, Rick, Jr. “A Key to Success Is Learning the Difference Between Advice and Opinion.” Linkedin. N.p., 1 Apr. 2015. Web. 19 Feb. 2017.
Thomas, John E, et al. “Case 5.1: Should Treatment Be Withheld from Patients with Severe Cognitive Disabilities?” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.
Hi Rylee,
I thought that your post was rather thoughtful! I completely agree with your argument regarding the physician’s insensitive, unnecessary opinion. It is imperative to consider that the doctor is in a role that grants him a great deal of authority–doctors are perceived as experts in their field, and offering opinions rather than facts, can detrimentally impact patient’s autonomy. As the mother is in a vulnerable state, the doctor should not have offered his values/opinions in such an insensitive manner.
However, I think it is interesting to consider whether or not doctors can provide recommendations without drawing from their personal experiences/biases. In a handful of studies, nearly 50% of specialist doctors reported harboring bias (Storrs). These biases have a profound impact on the care that patients receive. In my opinion, it is nearly impossible offer unbiased, factual recommendations–however, doctors should strive to be professional and offer medical opinions based on the patient’s best interest and personal wishes.
Here’s a really interesting article on physician bias in healthcare:
http://www.cnn.com/2016/01/19/health/doctor-patient-bias-survey/
Hi Rylee,
Great Post! I, too, agree that the resident was completely unprofessional. He definitely needs to be better trained on how to deliver information. For starters, he begins with a negative viewpoint from the beginning when he becomes angry at the mother for not transferring to the tertiary hospital sooner. This negative view translates in the discussion with the mother about her baby. If the mother had only heard what the resident had to say, she would have thought the baby had no chance of a normal life and would have been extremely disabled. But, when the pediatrician explained the outcome chances, the baby seemed to have a much better chance than the resident portrayed. I think that since since had a 1 in 4 chance of being normal and a 1 in 4 chance of being mildly disabled, she should definitely continue treatment. Additionally, the pediatrician mentioned a vital piece of evidence that the resident did not: withholding treatment might not kill her and could just make her condition even worse. I also think it’s very clear that the doctors should keep treating the baby because of both the non-maleficience and the beneficence principles. This case, in my opinion, wasn’t even meant to serve as a dilemma case, because it would be morally wrong for doctors to stop treatment. I think this case served to show readers how important it is for doctors to not let their opinions get in the way of presenting cases in a rational way. Residents, even though they are still under the supervision of a physician, are still “liable for medical malpractice” and therefore responsible for their patients. I believe that this resident needs to be reprimanded for the way he presented information to the mother, because if he wasn’t being supervised as well as the pediatrician did, then the mother could’ve potentially and unknowingly harmed her baby even more, and I believe the parents would’ve had grounds for a malpractice lawsuit.
Works Cited:
Thomas, John E, et al. “Case 5.1: Should Treatment Be Withheld from Patients with Severe Cognitive Disabilities?” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.
http://journalofethics.ama-assn.org/2009/11/hlaw1-0911.html
Hi everyone,
Like Kenquavius, I too was shocked by the residents tone. Did he really say “her outlook is really bad” and “I certainly wouldn’t want to grow up as a cognitively disabled, virtually impaired child” (187)? Does he lack all forms of compassion and sympathy? Unfortunately the data on malpractice suits suggests that 25,000 to 120,000 deaths each year are due to negligence or malpractice. Given this data, I think it is imperative that we reconstruct the way in which patient care is taught within medical schools. While knowledge of science and medicine is crucial to life saving, individualized patient care is just as important. The research suggests that patients in patient-centered medical facilities will establish a stronger sense of trust with their physicians that will only aid their recovery. In addition, patients treated heart attacks in hospitals with better patient-centered care show fewer symptoms and higher survival. I say its about time we get our heads out of the books, and start treating patients like human beings!
Noa
Cleary, Paul D. “Why Is Patient-centered Health Care Important?” WHY IS PATIENT-CENTERED HEALTH CARE IMPORTANT? (n.d.): n. pag. Scholarsstrategynetwork.org. Apr. 2012. Web. 23 Feb. 2017.
Oliphant, Ken. “Medical Malpractice and Compensation: Comparative Observations.” Medical Malpractice and Compensation in Global Perspective (n.d.): n. pag. Centerjd.org. Web. 23 Feb. 2017.