This article deals with the topics of patient autonomy and doctor interference with patient decision making and selectively sharing information. Patient autonomy is a common ethical issue in the medical field because there are so many exceptions and specific situations that may compromise the initial principles of patient autonomy. Doctors are expected to give all known information to the patient and patient confidentiality can also bring up a variety of issues within this field. The author, T. F. Ackerman, includes several arguments stating that illness can often greatly affect the patient’s ability to make a reasonable decision. There are many psychological and physical constraints that can affect the decision making process. Therefore, physicians should be able to participate in the decision making process, especially if the patient does not fully understand the illness or lacks the psychological wellbeing to make life changing decisions (Ackerman, 1982).

In the 19^th century, patients were expected to completely trust the judgements and decisions of the physician based on the beneficence model of the “golden age of medicine” in America. However, malpractice was common. Physicians could make controversial decisions such as declaring a severely disabled newborn as a stillbirth in order to prevent the parents from having a difficult decision to make or even withholding medicine from a patient. Ethical discussions did not take place often within the medical field. Because of this, many changes were made regarding the patient-physician relationship as time progressed (Will, 2011).

During the early 1900s, the number of hospitals in the US and the availability of medical technology and knowledge increased. Medical malpractice litigation became more popular in the late 20^th century and there was even a “malpractice crisis” during the Nixon presidency. The Nuremburg Trials revealed many ethical issues with patient consent and autonomy. These issues brought about mistrust towards researchers and even between patients and their doctors. Because of these events, new discussions developed about ethical reformations in the medical field, bringing about new ideas of patient autonomy and consent (Will, 2011).

In my opinion, I agree with Ackerman’s point that the doctor should be a part of the decision making process to some effect. A research study published in 2005 about patient preferences for decision making showed that majority of their patient participants desired to share decision making with their physician. Furthermore, no matter what their preference was, participants mostly valued the physicians opinion in most cases (Mazur,Hickman, Mazur & Mazur, 2005). Overall, physicians are the most knowledgeable about the patient’s conditions and can provide the most helpful and specific information possible. It makes sense for the physician to be allowed to intervene in decision making processes. This does not mean that patient autonomy is overridden; however, it is the physician’s duty to prevent and to not harm the patient which may involve intervention.

References

Ackerman, T. F. (1982). Why Doctors Should Intervene. The Hastings Center Report, 12(4), 14. doi:10.2307/3560762

Mazur, D. J., Hickam, D. H., Mazur, M. D., & Mazur, M. D. (2005). The role of doctor’s opinion in shared decision making: what does shared decision making really mean when considering invasive medical procedures?1. Health Expectations, 8(2), 97-102. doi:10.1111/j.1369-7625.2005.00315.x

Will, J. F. (2011). A Brief Historical and Theoretical Perspective on Patient Autonomy and Medical Decision Making. Chest, 139(6), 1491-1497. doi:10.1378/chest.11-0516