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.
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).