In their essay, Mappes and Zembaty explore the complex relationship between patient autonomy and familial obligations. Essentially, they argue that the concept of autonomy must be reevaluated, as there is a profound need to clarify the influence of family interests in a patient’s decision for treatment. After resolving the definition of autonomy, it is imperative to consider the need for hard paternalism when patient decisions diverge from family interests.

Although medical treatments apply to individual patients, the patients must consider factors beyond themselves when determining the best course of action, such as external issues and individuals.  A patient may consider a diverse range of issues, including financial burdens or familial stress, when choosing between various treatment options. As a result, the patient may evaluate external factors outside of the medical realm. One might argue that this particular practice threatens the conventional concept of autonomy, as family members exert undue influence and pressures on a patient to act in a certain manner (Ho). Under this particular argument, family members appear to threaten the patient’s decision-making ability. Thus, a fundamental question arises: does the consideration of family interests limit a patient’s autonomy, as the patient is not acting without controlling influences?

In this particular debate, it is imperative to consider the patient’s acknowledgement of familial interests. Generally, it is nearly impossible for a patient to make a decision without considering the impact on his or her family—patients tend to evaluate external factors that extend beyond their own health, happiness, and general being. Therefore, a patient’s interests can become easily intertwined with their family’s preferences. Despite the perhaps inevitable consideration of external familial interests, patients have the full authority to either act on or ignore the family’s preferences. Therefore, the consideration of family interests does not violate the patient’s autonomy, as the patient has the ability to weigh the potentially diverging obligations and determine the best course of action based on their personal preferences and values.

After establishing the preservation of autonomy in the presence of familial interests, it is important to clarify the role of the physician. Specifically, one must acknowledge the potential requirement of hard paternalism in cases when a patient’s decision does not align with the family’s interests. In the essay, the authors describe a case in which a competent stroke patient wants to rely on his wife as a caregiver, rather than entering into a nursing home (Mappes and Zembaty). If the physician respected the patient’s decision, then an intense burden will be placed on the frail wife. In addition, the patient does not yield a profound benefit by receiving care from his spouse, as he would receive better medical treatment in a nursing home. Therefore, the principals of nonmaleficence and beneficence outweigh the patient’s autonomy. Thus, the physician is justified in asserting hard paternalism to ensure the best outcome for the patient and his family.

References:

Hardwig, John. “What about the Family?” The Hastings Center Report 20.2 (1990): Web.

Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” JSTOR, 5 Feb. 2008. Web.

Mappes, T. A. & Zembaty, J. S. “Patient Choices, Family Interests, and Physician Obligations.” Kennedy Institute of Ethics Journal, vol. 4 no. 1, 1994, pp. 27-46. Project MUSE

As we know, respect for patient autonomy is a core principle in biomedical ethics. It recognizes a slew of patient rights, including their right to informed consent and their right to refuse treatment. In principle, it ensures respect for the patient’s informed decision, whether it agrees with the physician’s recommendations or not. And, in the case of disagreement between patient and physician, doctors reach a critical point and ask themselves, “do I intervene?” Some, on the principle of patient autonomy, choose noninterference, stepping back and giving their patient’s the freedom to make their own choice. But, does this truly respect their autonomy? In Terrance Ackerman’s article,  Why Doctors Should Intervene, he argues that noninterference does not respect patient autonomy because it does not account for what he calls, the “transforming effects” of a patient’s illness.

Now, you might be thinking, if respect for patient autonomy places nonintervention at its core, Ackerman’s argument is counter-intuitive. However, it makes sense in practice. Take patient competency. As Ackerman explains, certain constraints caused by a patient’s illness alter their ability to make a fully autonomous decision. These barriers can be physical, cognitive, or psychological, such as depression, anxiety, or even simple misunderstanding. He gives multiple examples of patients who, due to some impairment, can no longer make a decision and need a surrogate decision maker. In these cases, it is clear that intervention is justified because these patients are unable to make an informed decision. However, does this truly violate patient autonomy if the right to autonomy is not there in the first place? From previous discussions based on the writings of Beauchamp and Childress, we know that a patient’s right to autonomy is revoked if they are marked incompetent. So, in these cases, interference does not really violate anything at all. Noninterference, however, would not be in the patient’s best interest.

Take the anorexia case presented for our midterm. Bear with me now, as I know many of us disagree on which actions are justified. However, if we look at the case in favor of force feeding on the principles of beneficence and nonmaleficence, we see that intervention was necessary to save her life and in a sense, to give the incompetent patient her competence again. Ackerman mentions that loss of control is one of the worst things for a patient, so in cases of incompetency, is it warranted to remove patient control on the onset in order to fully restore patient control later on? In the force feeding case, for example, is it justified to go against her wishes for a short period of time in order to restore her to a healthy state of mind in the future?

If this is not pulling on your moral heartstrings already, it gets even more murky when the patient is competent. Some fully-competent patients (in terms of an absence of a debilitating cognitive or psychological illness) still succumb to bad decision making. Often, we put blind trust in our physicians because we think they know best. As Ackerman states, “many patients relinquish their opportunity to deliberate and make choices regarding treatment in deference to the physician’s superior educational achievement and social status. (“Whatever you think, doctor!”).” If a doctor takes their word and simply decides without any further discussion, a form of hard paternalism and noninterference, they violate patient autonomy (in the sense that they violate their right to an informed decision). Sure, the patient makes the decision to trust their doctor, but it is the doctor’s responsibility to be skeptical of this blind trust – especially when the patient has not heard all of the details. Ackerman suggests that doctors should “seek to neutralize” the constraints (whether big or small) so they may be more autonomous in future decisions.

Overall, patient autonomy should be respected. However, it can be respected in unconventional ways. Sometimes that is accepting the patient’s informed refusal, like in this case, while other times it is intervening to ensure the patient is competent and qualified to participate in fully autonomous decision-making. This was an interesting read for me and I look forward to hearing your thoughts!

REFERENCES

Ackerman, T. (1982). Why Doctors Should Intervene. Hastings Center Report, 12(4), pp. 14-7.

Beauchamp, T. & Childress, J. (2001). Principles of Biomedical Ethics. Oxford University Press.

Thomas, J. (2009). Well and Good. Broadview Press, 4.

Thaler and Sustein discuss the idea of “Libertarian Paternalism,” to describe when and why paternalism is justified and often entirely inescapable. They raise many good points about the prevalence of paternalism in nearly every decision we make, but they also make arguments based on low-stakes decisions that are, at least in my opinion, less sound.

One of the first major points the paper argues is that there are not actually any “viable alternatives to paternalism” because someone must make a choice whenever presented with a decision that involves others. This is logical enough because any decision that involves others, even when they naturally don’t have a choice or knowledge of the decision, could be seen as a mild form of paternalism. However, the authors on to argue that there are really only three options for decision making by an authority figure:

1. to make choices that are best for those effected (in this case best for the cafeteria customer)
2. to make a random choice
3. to consciously make a “malicious” decision that would hurt those effected (in this case make customers obese by arranging food a certain way).

While these are all alternatives, this is not a comprehensive list of options, intentions, and outcomes. For example, it is possible that the manager made a choice that she thinks is in her or the cafeteria customers’ best interest, or perhaps one that appears to be in the best interest of the customers, but actually has unexpected, adverse effects on them, her, or the cafeteria employees or revenue. Furthermore, decisions about the design and layout of a cafeteria are low-stakes compared to a treatment decision that is a life or death matter, or at a minimum can cause a patient unnecessary suffering and stress.

It is important that the authors value performing cost-benefit analyses of decisions at any level. The goal of the paternalism they aim to justify is to provide some choice, but to limit or entirely remove the possibility of poor choices being made. By nature, paternalism is “the intentional overriding of one person’s preferences or actions by another person…” (Beauchamp and Childress 215). This obviously means that autonomy is greatly compromised no matter what, and when this is the case, it’s imperative to be continually assessing the benefits and drawbacks of decisions and treatments.  But even with this constant monitoring of the situation, allowing some decisions while limiting autonomy is tricky to accomplish.

This article draws many conclusions about paternalism and its justification based on a very narrow scope of decisions: the fate of retirement money and a cafeteria’s arrangement. Because of this, both the authors and readers must be extremely careful about applying these arguments and principles to patient care. Most decisions are not as straightforward as how much money a retirement account will make based on a binary choice. Emotional harms are also important to consider; patients or customers likely do not have a strong emotional attachment to the layout of the cafeteria they’re eating in, but they will certainly have strong emotional responses to their treatment, pain, and violations of their autonomy. Paternalism is not clearly justified or unjustified, and the benefits consequences must always be carefully and continuously weighed.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print

The question that Ackerman presents at the beginning of the piece is something that I’ve pondered even before our class discussions. Does non-interference really respect patient autonomy? The answer is contingent on the situation. Time has a lot to do with how a patient absorbs, processes, and responds to a given situation. Humans are adaptive beings and our individual perception of normal is fluid. Children often see shadows and believe there are monsters in their closet so they are afraid of opening the door but through experience learn this is normal and a part of life. Though it may be a simple example, this is how we compile schemas over time.

Coping mechanisms change with time and with illnesses, this is often the case: you learn that this is the present and the past is no longer where you are in the time spectrum. When the situation is new and unfamiliar it sometimes over reaches our already “programmed” mechanisms and we are forced to develop a new schema (Hack, 237). I personally experienced this at the beginning of the fall semester I was diagnosed with Lyme disease, a condition that causes joint pain, fatigue, and severe headaches and is often accompanied by cognitive impairment. Symptoms are hard to manage not only because of the variety but also because intensity varies from day to day and recovery is not linear. The research is limited and often inconclusive, leaving most physicians unqualified to treat the disease. Therefore, many patients, like myself, heavily rely on the advice and expertise of a specialist. Pelligrino’s point that “The state of being ill is therefore a state of ‘wounded humanity’, of a person compromised in his fundamental capacity to deal with his vulnerability” is spot on (Ackerman, 15). Not only are long-term goals affected but the way in which one goes about their daily routine can be abruptly altered. I went from being able to practice for 2 hours a day to being unable to physically lift myself out of bed.

Experiencing intense physical pain with little relief is uncomfortable but the cognitive constraint is much worse. I was so overwhelmed with the new day-to-day me that I lost the ability to confidently make choices. It could take me an hour to make a simple decision of what cereal to eat for breakfast and even after I finished the bowl I was still unsure if I made the “right” decision. The immense pressure that new patients feel to make only “right” decisions is mentally and emotionally taxing and can compromise the patient’s own autonomy (Schofield, 2). The argument can be made that considering the situation, although competent, I was not in any condition to give informed medical consent and neither was my family. It’s necessary to acknowledge the slippery slope of violating patient autonomy when the physician takes on the responsibility of decision maker but before the patient has adjusted to their new normal it may be necessary for their long-term well being.
Ackerman, T. F. (1982). Why Doctors Should Intervene. The Hastings Center Report, 12(4), 14. doi:10.2307

Hack, T.F., and Degner, L.F. (2003). “Coping responses following breast cancer diagnosis predict psychological adjustment three years later.” Psycho-Oncology, 13(4): 235-247.

Schofield, P. E., Butow, P. N., Thompson, J. F., Tattersall, M. H., Beeney, L. J., & Dunn, S. M. (2003, January 01). Psychological responses of patients receiving a diagnosis of cancer. https://academic.oup.com/annonc/article/14/1/48/130229/Psychological-responses-of-patients-receiving-a

In Mappes and Zembaty’s essay, “Patient Choices, Family Interests, and Physician Obligations”, they discuss John Hardwig’s conceptions of autonomy.  Hardwig, proposes two forms of autonomy, A1 being “the patient’s freedom or right to choose the treatment he believes is best for himself” and A2 as “the responsible use of freedom” (Hardwig, 1990).  Hardwig believes that A1 is the “accepted meaning” of patient autonomy, despite rejecting this concept and proposing A2. What is to be thought of Hardwig’s suggestion?

I do not agree with Hardwig that A1 should be completely rejected, but I think A2 provides a new and important argument to the idea of patient autonomy. Individuals that are competent and capable of making decisions about their own medical treatments and such should have that power and freedom. With that being said, the expectation of those that qualify to make their own choices if that they will use this right responsibly and sensibly. However, in more complicated situations, such as when patients are deemed incompetent or are unable to make decisions about their own health due to unforeseen circumstances, the idea of “the responsible use of freedom” should then be applied to that of the surrogate decision maker.  For example, in case 1.1, Marie Francois has complications during surgery and is in need of another operation otherwise she will most likely die.  She communicates by way of written notes that seem rational, but her oldest son claims that she does not understand the consequences of her refusal.  I think that Hardwig’s proposed idea of patient autonomy seems appropriate.  If in fact she is competent, she is responsibly using her freedom and has the right to refuse treatment if she so chooses.

Rather than completely rejecting A1 and fully accepting A2, I would propose a slight alteration or rather combination of the two.  I believe patient autonomy should be defined as the patient’s responsible freedom or right to choose the treatment he believes is best for himself.  I still think that it is the competent patient’s right to make decisions, but with this freedom comes an immense responsibility as well.  By combining the definitions, it holds the patient accountable for their actions, but still presents them with the freedom to make their own choices about their health.

 
After reading Hardwig’s argument, I was curious to see how others felt about the concept of autonomy and found an article arguing that autonomy should only be an instrumental value rather than an intrinsic one in terms of medicine.  The author went on to explain that our society over values autonomy in terms of patient wellbeing and that this concept should be rejected.  I am one to greatly value my autonomy and was somewhat surprised after discovering this article.  If we act responsibly, why should our freedom be limited when it comes to our own decisions about health? Before my family travelled to Peru over the winter break, I had to go to the Emory Travel Well Clinic and get specific shots and learn about the risks of travelling to this area of the world. The healthcare professional informed me of a new available vaccine that she recommended, but that I was not required to receive.  However, the vaccine could possibly result in severe side effects.  In the end, I decided against having the vaccine.  Despite the doctor being more knowledgeable on the subject, my autonomy was still respected even if she disagreed with my decision.  I disagree that patient autonomy is overvalued and think it is incredibly important that patients are able to responsibly use their freedom.

Works Cited:

Hardwig, John. “What about the Family?” The Hastings Center Report 20.2 (1990): 5. Web.

Mappes, T. A. & Zembaty, J. S. “Patient Choices, Family Interests, and Physician Obligations.” Kennedy Institute of Ethics Journal, vol. 4 no. 1, 1994, pp. 27-46. Project MUSE, doi:10.1353/ken.0.0065

Thomas, John E, et al. “Case 1.1: When Physicians and Family Disagree.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 2014.

Varelius, Jukka. “The Value of Autonomy in Medical Ethics.” Medicine, Health Care, and Philosophy 9.3 (2006): 377–388. PMC. Web. 15 Mar. 2017.

Beneficence and nonmaleficence are two ethical principles that our society relies heavily on and although they may have similar intentions, they each possess distinguishable characteristics. According to Beauchamp and Childress, nonmaleficence calls for prohibition of harm, is impartial (obligation not to harm people in general) and is often considered the moral basis for law. On the other hand, beneficence is a call for positive action, may be partial (not obligated to help all people in all situations) and, unless it is explicitly required for your profession, is not the moral basis of law (Beauchamp and Childress 205). Beauchamp and Childress also lay out a series of five conditions that comprise the duty to rescue which take into account the necessity and benefit to the person in need, burden to the helper and probability of the result/benefit (Beauchamp and Childress 207). One argument is that if the helper faces a low risk/burden to help someone in need, and such help has a high probability of positively affecting the person in need’s life, the helper has a moral obligation to do so. Situations in which the probability of success is low, there is a high risk for the helper or the help provided is not absolutely necessary to the survival of the person in need, there is no obligation to help this person, but doing so would be considered a supererogatory act.

https://www.youtube.com/watch?v=ufhKWfPSQOw

At the end of class we began to discuss where the principle of beneficence falls in terms of foreign affairs. Do we have a moral obligation to help other countries in need? Should we provide aid to countries in war that are our allies or intervene in countries with corrupt government? Attached to this post is a video of Yeonmi Park, a young woman who escaped from North Korea, recounting some of the horrors she experienced growing up at the One Young World conference. She talks about seeing parents of friends murdered for watching Hollywood movies, witnessing rape and even admitting that when she was younger she believed that the dictator could read her mind and that she could not think anything in opposition to the dictatorship. The stories she discusses are horrible, as is evidenced by the teary-eyed faces in the crowd and the pit in my stomach I felt as I watched the video. At the end of the video I wanted nothing more than to help or for someone to help this girl and other girls like her who are victims of the country they were born in. The conditions of North Korea are terrifying and inhumane, yet not much or at least not enough is done to protect those who are stuck living there.

Does the principle of beneficence apply here? As stated above, beneficence is sometimes partial and not the moral basis of law, so legally we do not have an obligation to help, but should we? Other women and citizens of North Korea like Yeonmi are in desperate need of help and face serious risks everyday; however would actions on behalf of the United States realistically prevent this harm? Are the risks and burdens involved for the United States too great to overcome the potential benefits to the North Koreans?

While intervening in foreign affairs is often controversial, do we as moral beings have an obligation to step in in the name of beneficence? Or is any such action of beneficence to another country considered supererogatory?

Citations

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print

OneYoungWorld. “Escaping from North Korea in Search of Freedom | Yeonmi Park | One Young World.” YouTube. YouTube, 18 Oct. 2014. Web. 14 Mar. 2017.

Terrance Ackerman’s response to Childress and Beauchamp’s idea of autonomy attempts to address the notion a physician’s interference with a patient’s decisions that may exhibit impaired autonomy when under the effect of an illness. In my perspective, this is necessary when attempting to ascertain the level of autonomy which may influence the weight of their choice in the matter. In his essay, he highlights a quote by Childress and Beauchamp, that states, “To respect autonomous agents is to recognize with due appreciation their own considered value judgments and out- looks even when it is believed that their judgments are mistaken.” This ideology leads to the noninterference of physicians into the personal matters of the patients. While for many cases this may be viewed as morally correct, Ackerman proposes a concept that contradicts this moral answer of respecting autonomy. What if an illness eventually begins to impede the ability of the patient to competently make a decision that reflects his or her life goals? It would not seem ethical to allow a patient to cause themselves harm in due to a decision that was the consequence of the illness. For example, this situation was similarly addressed during our midterm with the case of a female not wishing to die yet refusing to consume food due to her condition of anorexia. On one hand, you could respect her autonomy and conduct noninterference policy by allowing her to waste away, yet you violate her life goals by permitting her death. On the other hand, you could overrule her autonomy by interfering with her choice of treatment, yet this view corresponds with her life goals. Since anorexia nervosa is as much as a neurological disorder as an eating disorder, allowing an incompetent decision that is dictated by the disorder could cause detrimental damage to the patient whom may not have been fully aware of the consequences in addition to contradicting their life goals. While Beauchamp and Childress’s idea of noninterference may be applicable in some instances of a competent and autonomous patient, perhaps a concept similar to Ackerman’s idea of a physician’s interference to promote return of control could be more useful in supporting patient life goals whose judgement is clouded by the illness that affects them.

Works Cited:

1. Ackerman, Terrence F. “Why Doctors Should Intervene.” The Hastings Center Report 12.4 (1982): 14-17.
2.  Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001.
3. Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Ontario: Broadview Press, 1987

In the beginning of this article, the topic of autonomy was dissected. He directly reasons against Beauchamp and Childress’ definition of autonomy. Ackerman describes the two conditions in which a person is fully autonomous, when: 1)”behavior is governed by plans of actions that have been deliberated through deliberation or reflection” and 2) the behavior “intentionally and voluntarily” stems from a person’s life plans.  And with these qualifications of an autonomous person, Ackerman thus argues that illness causes the affected person to not achieve these requirements. He posits that illness, both physical mental, causes a person to make biased decisions that do not reflect full autonomy.

However, I feel that this argument contains many flaws. One being that the question of autonomy is very prevalent for those who suffer from illness.In an example, a man ‘irresponsibly’ chooses to not have life-saving neurosurgery because of the “cosmetic affects” and “possibility of neurological damage.” The critique is that the illness caused irrational thought-processes to occur and the person makes a decision that they would have made without the illness.  I further contest that argument as another one of his reasonings to why illness dissolves autonomy, is that it makes a person decide that they hadn’t otherwise. He gives the example of the woman with continuous diagnoses of cancer refusing treatment after her last diagnosis. The claim was that “it was unlike her” to refuse treatment as she has not refused before. It was due to her depression that make this “new” decision for her, according to Ackerman. However, you can only judge who a person is by their reality, and their reality is being ill. To say that the woman would not have refused treatment if she were not depressed is too speculative to remove her status as an autonomous being. As a person potentially undergoing treatment, she has the right to decide if she should go through another round. Specifically this woman has suffered many bout of cancer, and has had treatment help her but only for her to become sick again. And due to her complications this time, her willingness may be decreasing . Not directly due to her newly-developed depression. Also you can’t judge a person’s choice simply on what she has agreed to before. In that case, what is the point of asking consent for treatment for a chronically ill-person?

To say that people who are suffering from something do not posses autonomy is also problematic, as this would lead to doctors or individuals close to the “ill person” to have more say in treatment (or lack thereof) for the individual. Ackerman continues to pose that noninterference is the not the best mode of action for doctors, and should not be acted on. He says that because an ill person lacks autonomy, the doctor must have a role in decision making. Because of the doctor’s expertise, his/her opinion should definitely be taken to account. However, they should only have a firm role in decision of treatment, if the person’s autonomy and abilities are greatly diminished or existent. As long a person’s decision to undergo treatment or not does not harm another, their choices should be respected. As blurring the lines of medical consent and status of autonomy can cause a slippery slope in how people and their illnesses are approached by medical professionals. This can cause exploitation and harm to those vulnerable populations that may not have the ability to directly/properly contest a doctor’s opinion/recommendation.

References:

Ackerman, Terrence F. “Why Doctors Should Intervene.” The Hastings Center Report 12.4 (1982): 14-17.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001.

Paterick, Timothy J., Geoff V. Carson, Marjorie C. Allen, and Timothy E. Paterick. “Medical Informed Consent: General Considerations for Physicians.” Mayo Clinic Proceedings 83.3 (2008): 313-19.

We define respect for autonomy as “[requiring] that autonomous actions not be subjected to controlling constraints by others” (Beauchamp and Childress, 107). At the core, it seems essentially unreasonable for a physician to disregard respect for autonomy as by this definition one would be “controlling” a patient in need. Where the lines begin to blur, though, is when you bring in the patient’s state of being to the table. A patient’s impediment to their ability to make autonomous decision can range from mental and physical capacity, emotional state, social and cultural limitations, among other things. These “various kinds of constraints can impede autonomous behavior” (Ackerman, 15). The question we ask is when is it okay for doctors to step in and override a patient’s wishes?

In previous cases we have studied, we see this dilemma quite often. For example, in our latest case we saw a 21-year-old anorexia patient who refused to be force-fed, even though she would likely go into cardiac arrest after a few days. Our patient, Amelda, seems to fit all the criteria for being considered mentally stable, minus the fact that she does not comprehend the full consequences of her decision not to be force-fed. The argument here was that she was determine incapable of making her own decisions without probable cause. This blurs yet another line between the patient-physician relationship of when a patient can be determined incapable of making his/her own choices. Amelda’s doctor and parents considered her inept to make sound decisions in this case, but had she gotten a second opinion, another physician may have disagreed. Different opinions from different physicians essentially causes human error when evaluating whether or not a patient’s autonomy should be rightfully violated.

Violating a patient’s autonomy leads to a slippery slope of violating the principle of informed consent as well. In Amelda’s case, when the doctors gave her a feeding tube against her will, her autonomy was violated as she did not explicitly ask for the treatment. In turn, this means that she did not give informed consent and that that principle was violated as well. Essentially, by not respecting a patient’s autonomy in the context of a given treatment, even when it is lifesaving, both informed consent and autonomy are not upheld in an ethical sense. While this could be considered a case by case basis, the principles and rights of a patient are all the same and it should be considered no different if a person refuses a cosmetic surgery or a lifesaving surgery. In any situation, a patient’s autonomy should be maintained despite the possible consequences due to the slippery slope that would quickly ensue if that right was not upheld. In the end, no doctor should not intervene in a patient’s decision to forgo or continue treatments; only give support and information to the best of their ability.

Works Cited:

Ackerman, Terrence F. “Why Doctors Should Intervene.” The Hastings Center Report 12.4 (1982): 14-17. JSTOR.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.

Thomas, John E, et al. “Case 3.3: Discontinuing Forced Feeding of an Anorexia Nervosa Patient.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 2014.

This article by Terrance F. Ackerman describes the two, sometimes clashing, notions of patient autonomy and physician interference. Patient autonomy is a necessary staple in the doctor patient relationship. It needs to be considered when dealing with patients when it comes to a multitude of scenarios including sharing information, deciding treatment plans, prescribing prescription medications. Ackerman defines patient autonomy as having two key features. The first of those being that: “autonomous behavior is governed by plans of action that have been formulated through deliberation or reflection” (Ackerman, 1982). The second is then stated as: “autonomous behavior issues, intentionally or voluntarily, from choices people make based upon their own life plans” (Ackerman, 1982). These two stipulations are important but can be impeded by certain constraints described Ackerman. These constraints can be physical, cognitive or psychological. Doctors are required to respect autonomous patients however what happens when a patent is constrained by a number of factors in terms of making logical decisions? This is where physician interference comes in.
Non-interference is the physician’s role in patient decision-making. This topic can be difficult to balance with autonomy. Where is the line in which a doctor’s opinion is helpful rather than pushy and unnecessary? Is it possible for non-interference to respect patient autonomy? This also raises the question about how much say should doctors have in medical decisions their patient’s make. Also is that say hindering patient autonomy?
I think these questions can be assessed in a case-by-case basis. While physician interference isn’t welcomed in all cases, I think its necessary in certain situations. I think it’s important for a physician to inform the patient on certain risks or probabilities from the biological standpoint. In terms of certain diseases, the doctor comprehends the course and should inform the patient on the reality of the situation and what they believe is best. For example if a patient is diagnosed with a rare disease, it is the doctors obligation to help provide the patient with the necessary information in order for them to be able to make coherent decisions regarding their medical care. A doctor should no attempt to guide a patient towards a course of action they believe is best, but they should provide the individual with essential information to decide for themselves. Another case would be one in which a patient’s competency is in question. This goes back to Ackerman’s discussion of constraints that impede patient autonomy. If a patient is incapacitated due to physical, cognitive, or psychological constraints then self-governance is obstructed. This is a time when a doctor must interfere in order to make a decision for the patient. In other situations the line is more blurred. A patient’s decisions must be respected and taken seriously by the physician. I think the physician should be able to weigh in on the decision and should be available to answer any questions the patient may have but in order for autonomy to be unharmed, the patient must reach a decision on their own terms.

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

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.