A Right to Life

          In his essay “Autonomy and the Refusal of Lifesaving Treatment”, Bruce Miller claims that the concept of autonomous persons requires physicians to put aside any of their values and opinions in an obligation to respect a patient’s wishes (22, 1981). We know that physicians are tasked with the duty to save people’s lives, which makes the perplexing cases Miller brings up rather troubling. Is a person’s autonomy more important than a physician’s obligation to save lives? Miller claims that autonomy has four “senses” we should consider in order to help us answer this question. One of the senses Miller evaluates is “autonomy as effective deliberation”. Autonomy in this sense, Miller claims, occurs when a patient has knowledge of risks, alternatives, etc. and weighs these possibilities rationally (24, 1981). Therefore, the patient is autonomous only by free action (i.e. the patient makes a voluntary choice). This makes case 3, a hard case to understand because the patient wants to have the right to die, even though the treatment does not seem to have any negative side effects from what we read in the passage. This seems highly irrational and MIller believes that in cases like this, the physician is obligated, at the very least to encourage the patient to make a decision that involves effective deliberation as well as authenticity (27, 1981).

          Miller claims that autonomy through effective deliberation is something that is protected by informed consent; the patient should know of the consequences and alternatives and then weighs and evaluates both to come to a logical decision(25, 1981). However, a disturbing case in Canada challenges the principles of autonomy in all of the senses that Miller identifies. A 46-year old man, Mann Kee Li was diagnosed with cancer, but wanted doctors to do everything in their power to save his life. WIth this in mind, physicians decided to order a “do not resuscitate” order upon Li. They argued that any further treatment or intervention would have no benefit to the patient. The hospital’s vice president claims that physicians are not obligated to provide treatment that offer no benefit. Although the doctors might not be able to do anything further to treat Li, an order of a DNR means that should Li’s life suddenly be threatened, doctors are legally obligated not to resuscitate him. It is one thing to question whether or not someone is making an effective deliberation about whether or not they should die rather than receive treatment, but I do not think we can question Li’s effective deliberation that his life is one worth living. One thing that cannot be denied is that a physician’s duty, first and foremost, is to do all they can to save someone’s life. We can argue that a person’s autonomy may or may not outrank this right, but when a patient tells a doctor not that he has a right to die, but that he has a right to live, it seems inhumane not to honor it.

Works CIted

Miller, Bruce L. “Autonomy & the Refusal of Lifesaving Treatment.” The Hastings Center Report. no. 4 (1981): 22-28.


Cribb, Robert. “Family, doctors battle over ‘do not resuscitate’ order.” The Toronto Star, , sec. Life: Health and Wellness, Oct. 25, 2010. http://www.thestar.com/life/health_wellness/2010/10/25/family_doctors_battle_over_do_not_resuscitate_order.html (accessed February 16, 2014).


8 thoughts on “A Right to Life

  1. I thought it was great how you posed the question: Is a person’s autonomy more important than a physician’s obligation to save lives?

    Like I’ve mentioned in other comments, I think that a person’s autonomy is more important than a physician’s obligation to save lives because I think that people have the right to decide for themselves what they want done or not done to them, if they are capable of doing so (old enough age, mental stability, capable of making own rational decisions, etc). Though it’s frustrating for physicians to have to not perform what they believe is the best thing for the patient, it’s important that the patient agrees to the doctor’s suggestions and that the doctor listens to any possible refusals.
    Doctors can be convincing. Anyone can be convincing if they really know what they’re talking about and are extremely confident in their knowledge. Therefore, I believe that, most of the times, doctors are very confident in their knowledge and are able to pass that confidence to their patients, who will, then, listen to what the doctor says.
    I also think it’s important for a doctor and patients to develop a healthy relationship because the sense of trust and communication will definitely allow better agreement from the patient.
    Additionally, I agree with you on your last point when you say that we should honor a patient’s decision when he or she tells the doctor that he or she has a right to live. However, I don’t think there’s ever really a debate about this because the ultimate goal is survival, right?

  2. I believe that a person’s autonomy is more important that the physician’s obligation to preserve lives. Similar to a close relative or friend, physician’s have a duty to share his/her recommendations and what they believe is best for the patient; however, ultimately, it is the patient’s decision. The only case in which autonomy should be overridden by physician duty is when a patient’s decision is not coming from a place of true autonomy, most of the four senses being compromised , which Miller did a good job in demonstrating through his four cases (though the outcome of the first case was baffling). We must be careful when we begin to tack on additional stipulations regarding the validity of autonomy; when healthcare professionals begin to consider too closely a patient’s life and whether their decision to refuse care seems rational. As Miller said in his article, this leads us to question who it is that is ultimately making the decision? Who is a physician to determine whether an individual’s decision makes sense and should be adhered to? Unless it is the a case in which a patient’s ability to make a decision is compromised (the four senses of autonomy), the patient’s wishes in the refusal for treatment should be theirs alone.

  3. You bring up a very relevant issue and very difficult ethical debate: what should a physician do when a patient’s autonomous decision conflicts with the physician’s duty of beneficence. According to the Hippocratic oath, physicians have an obligation to do no harm and to also help patients, thus doing what is in the patients interest. For example, a patient with an infection may refuse antibiotics or a patient who had bypass surgery may continue to smoke. In these situations, the patients is not complying with actions that the physician recommends in the interest of helping the patient. In these circumstances, following the principle either autonomy or beneficence would lead to different actions. So which action is the morally right choice? This involves a balance of these two principles and acceptance by the physicians. As long as the patient is making a fully autonomous decision (fully understands and acknowledges the implications of the decision), then the physician has the obligation to respect the patient’s decision, even if recommending the opposite choice.

    The balance between autonomy and beneficence becomes confused with the issue of coercion. What is the line between strong recommendation or argument for a particular choice and coercing a patient? A patient is in a particular vulnerable position: they need the guidance of a physician with far greater medical education and knowledge than them. Therefore, could a situation be classified as coercive if a doctor is making a very strong argument when the patient is unable to understand the meaning of the risks adequately? Once again, adding complications to the balance of beneficence and autonomy.

  4. Mr. Li’s case is intriguing because usually the dilemma is whether or not the patient should be kept alive even if they request to be left to die. In this case, many would argue (as you have stated) that the patient has a right to die. Likewise, patients should definitely have a right to live. It is not necessarily clear why he would want to continue living, but there might be some personal reasons behind his decision. Perhaps there are religious beliefs behind his decision, and he believes that a miracle could arrive and alter his condition in his favor. Perhaps he is trying to hold on long enough to say goodbye to all of his family. Perhaps he has not yet made peace and wants to let go when he is ready. These and many other possible reasons prove that the patient has a right to life. On the contrary, from the physician’s point of view, the hospital could be overcrowded and his bed may be needed for someone who actually has a chance at living. Maybe the hospital bills are inconveniencing his family members and they are okay with the physician’s decision. Hence, their choices are justified as well. Nevertheless, the patient should have a right to live just as much as they have a right to die.

  5. I too found the question “Is a person’s autonomy more important than a physician’s obligation to save lives” incredibly interesting and complex. I can’t imagine being in the position of a physician that is completely helpless, unable to act and save a patient, because they chose to refuse medical treatment. However, I do believe that a person’s autonomy outranks the physician’s duty to save lives. People have the right to chose what is and is not done to their bodies and as long as they are mentally capable of determining this in a way that meets the 4 guidelines for autonomy, I think their wishes should be respected. I think a physician that choses to ignore these requests and force treatment or revival on a patient that doesn’t want it gets into the “playing God” argument. Why is it the physician’s duty to decide whether an argument against treatment is valid or not? If the person is clearly capable of making a educated decision, I think it should be accepted.

  6. The question, “is a person’s autonomy more important than a physician’s obligation to save lives”, is a stimulating question in the realm of bioethics. The conflict between patient autonomy and physician judgement comes up in countless medical cases. However, this question is intensified when applied to cases regarding the refusal of life saving treatment. It is nearly impossible to create a universal code of ethics that can be applied to these types of cases, leaving physicians to balance their own ethics against patient autonomy in the majority of cases. When physicians are left to their own ethics, it is often difficult to find convincing evidence for physicians to honor patient autonomy, as most cases are not clear cut. Thus, physician knowledge and expertise tends to override patient autonomy for number of reasons. Firstly, it is often difficult for physicians to determine whether patients are in a rational frame of mind to make such pressing decisions. Secondly, when we look to the other levels of autonomy outlined by Miller, it is often difficult to determine whether a patient’s wishes meets all four degrees of autonomy. In such cases, physicians may not feel comfortable agreeing to patients wishes when there is not substantial evidence that patients are capable of such serious-decision-making. In these cases, a physician would feel more comfortable trusting their own instinct, values, and expertise. Thirdly, many patients develop a relationship which their physician in which they trust them to make the bulk of their medical decisions. When a physician is trusted to rely on their own judgement in medical decision-making, they are likely to rely on their own ethics as opposed to the patient’s values.

    In the case of Li, however, I do feel that the answer was more clear cut than the doctor might have believed. Li’s beliefs about treatment were expressed; he asked the doctors to do everything that they could in order to save his life. In this situation, I think the doctor relied too heavily on his own personal beliefs about Li’s medical situation, as he wasn’t even willing to try treatment. While the stage and severity of Li’s cancer was not expressed in this post, I still believe that the doctor had the obligation to honor Li’s autonomy and do whatever he could to try to save his life.

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