Category Archives: Uncategorized

Children and Autonomous Decisions

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What is the stance on children’s autonomy? How much involvement should a child have in a personal health-related decision? In “The Place of Autonomy in Bioethics,” Childress writes that “the presence, absence or degree of autonomy is a morally relevant characteristic” (Childress 312). This means that if we are deciding on the level of autonomy for a child, leaving them no opportunity for autonomous decision-making could be a possible violation of respect for autonomy.

Chlidress frames it perfectly: “Complexity of respect for personal autonomy.” In children especially, there is a huge grey area for making autonomous decisions with respect to healthcare. In 1995, the American Academy of Pediatrics released recommendations for pediatric decision-making. The AAP divided children into 3 levels of capacity: lacking, developing, and having capacity to make health-related decisions (Ross). The main guidelines regarding children with less capacity for making decisions include “seeking parental permission,” seeking “third-party mediation for parent-child disagreement,” and overruling the child’s decision if it goes against life-saving treatment. This seems fair, assuming that the child is inexperienced in life, unprepared to make an informed decision, and the parent makes a well-informed decision that is in the best interest of the family. For more mature children, the parent becomes a consultant rather than a consenter (Ross).

The major issue with the AAP recommendations is that no guidelines or tests exist to determine the level of decision-making capacity of a child! This means that the physician or pediatrician is the one who decides whether the parent will be a consultant or a primary decision-maker. Of course, if the parent makes a decision that is “abusive or neglectful,” the pediatrician can overturn that decision (Ross). Also, hospitals normally have an ethics committee that handles these kinds of situations, and issues are dealt with on a case-by-case basis.

Another important point to note is that people exist in and through time and their choices and actions occur over time” (Childress 310). A parent may be the primary decision-maker, but the parent must also think about the child’s future- will this child be happy in the future with the decision the parent made? Could this be a violation of autonomy if the child opposed the parent’s decision? What if the child was at an age that the degree of autonomy was sufficient, but the child’s opinion was still ignored? Childress supports this idea by stating “we also have to put that patient’s present consents and dissents in a broad temporal context encompassing both the past and the future” (Childress 310). Veatch argues against allowing the parents full consent, because they may not actually have the child’s best interests in mind- they think about money, parental obligations and their other children, among other things.

We must not abandon personal respect for autonomy, even in the situation that the patient is a child. A final decision should be balanced and thoroughly discussed and understood by all who are involved. Coercion or force should only be used as a last resort (Ross).  In “Abandoning informed consent,” Veatch says “it would be extremely difficult to determine whether the absolute best choice has been made” by the parent, but after reading these articles I believe their decision should be considered above the child’s or the physician’s opinion.

 

 

 

 

References:

Childress, James F. “The place of autonomy in Bioethics.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 308-316. Print.

 

Ross, Lainie Friedman. “Health Care Decisionmaking by Children Is It in Their Best Interest?” The Hastings Center Report. 27.6. (1997): 41-46. Blackwell Publishing Ltd. Web. 23 Feb 2014 http://dx.doi.org/10.2307/3527717.

 

Veatch, Robert M. “Abandoning informed consent.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 317-328. Print.

http://www.wordle.net/show/wrdl/7588721/Wordle_Children_autonomy created by Jackie Glodener. 24 Feb 2014.

 

 

 

 

First, Do No Harm

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Though the field of medicine during the times of ancient Greeks is very outdated, The Hippocratic Oath is one concept that remains important even to this day. Particularly, there is one line that the general public expects medical professionals to observe: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice” (Tyson). Interestingly, physicians are expected to judge the best interest of the patient in order to do no “harm or injustice,” but how can one person be expected to determine what is best for another person? Of course, any morally sound clinician wants to ensure that the patient receives the best treatment possible, but to accomplish this they must first combine their professional knowledge with the precise knowledge of every patient’s best interests – a feat that is simply impractical.

According to Veatch, in order to implement a treatment while simultaneously respecting the patient’s best interests, a medical professional must adhere to three principles. First, the clinician must ensure that the patient’s medical needs are met; second, the clinician must ensure that the patient’s other non-medical interests are respected; and third, the clinician must be able to uphold various other societal morals and laws even if these may conflict with the patient’s best interests (Holland 320). As Veatch states, all three of these assertions have the possibility of conflicting with each other. For instance, in a case in which a Jehovah’s Witness has a communicable intestinal disease needs to undergo a critical operation, the surgeon explains that the procedure would require an intestinal bacteria transplant (bacteria from the gut of a healthy individual is transplanted in another individual). He offers an alternative treatment regimen that involves cleansing the gut with potent medications, but this has a very high risk of serious irreversible damage. It is in the patient’s best medical interest to undergo the surgery because the risks are lower, yet this would not be in the patient’s best moral interest. The patient may refuse both treatments and may be willing to live with the disease, although she can spread this disease, which is deadly to other individuals. Thus, the clinician is obligated to treat the patient in order to benefit the greater good, yet this violates the patient’s religious interests and/or her medical and autonomic interests. The clinician and the patient could both agree to the alternative treatment, but this encroaches on the patient’s medical interests. The clinician could leave the patient quarantined for the rest of her life, but this would not be in her best medical and autonomic interests. Subsequently, which option is the best for the patient?

This scenario may seem outlandish, but this is very loosely based on the case of Typhoid Mary. She ended up being quarantined for her last few years of life.

In addition to respecting all three of these factors, medical professionals are guessing to determine the patient’s interests. The most efficient way to diminish the amount of guessing which treatment may work best is for the clinician to strengthen their personal relationship with the patient. Unfortunately, even though the doctor can be “generally warm and caring,” patients may still feel as if there is a distance between them and their physician (Chen). Some people have problems that they would not even tell their best friend, let alone a medical professional who might be a stranger to them. To some patients, medical professionals are experts of their body and know what is best for them with regards to treatment. “Some even said they feared retribution by doctors who could ultimately affect their care and how they did” (Chen). An analogous situation is the classroom setting. Some students often feel afraid to question the authority of the teacher, even if it best serves their learning environment, because the teacher has the ultimate say in their grade. In the medical setting, however, the physician has the ultimate say on the patient’s life.

Essentially, it is nearly impossible for a clinician to act fully within the interests of any individual, especially if they do not know the patient on a personal level. In order for the physician to ensure that most of the patient’s needs and desires are met, the doctor-patient relationship must be strengthened. For this to occur, medical professionals should be more personable to patients in order to make them feel comfortable with divulging information. Meanwhile patients should view their physician as just an average human being with whom they can share their opinions and ideas.

 

Sources:

Chen, PAULINE W., M.D. “Afraid to Speak Up at the Doctor’s Office.” Editorial. Well. The New York Times, 31 May 2012. Web. 23 Feb. 2014. http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_php=true&_type=blogs&_r=0.

Rosenberg, Jennifer. “Typhoid Mary.” About.com. N.p., n.d. Web. 23 Feb. 2014. http://history1900s.about.com/od/1900s/a/typhoidmary.htm.

Tyson, Peter. “The Hippocratic Oath Today.” NOVA. PBS, 27 Mar. 2001. Web. 21 Feb. 2014. http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html.

Veatch, Robert M. “Abandoning Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 318-28. Print.

Reforming Informed Consent

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Robert M. Veatch’s article argues that informed consent should be abandoned due to its uses as a “transitional concept” and ambiguity (Veatch 317). Veatch provides several examples to support his argument, among these include the “best interest standard”, how a person defines well-being, and physician bias (322-334). All of Veatch’s examples are accurate; with our current health care system it is difficult for physicians to make recommendations or conduct procedures on patients. Two important supporting facts of Veatch’s argument are that “actual consent is not obtained in all cases” and that the concept of informed consent is a relatively recent occurrence (317-318). Patients may also misinterpret the benefits and risks of a procedure (Krumholz 1190). However, in present day Western society I do not think that we would be able to eliminate informed consent. There are too many legal ramifications that could occur which will only require unnecessary spending. In order to find a median between informed consent and the best interest of the patient I suggest that the physician-patient relationship be adapted.

Many of the information against consent were rooted in the physician-patient relationship. American health care does not place great emphasis on time spent with the patient, which does not allow physicians to get to actually know their patients. Many of the issues Veatch present deal with this lack of relationship. This suggests that improving and strengthening the relationship between the two parties would be beneficial for both.

An article by Dr. Harlan M. Krumholz poses a potential solution to improving the consent process. Dr. Krumholz suggests a patient centered approach. Patient centered care focuses on “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (Krumholz 1190).  This means that the physician must have a minimal understanding of who their patient actually is. By acknowledging and working with the patient based on their values, many of the issues that Veatch brings up become irrelevant. To improve patient knowledge about procedures and to improve the process of giving consent Krumholz suggests that patients should receive a “brief standardized and personalized informed consent document” that would cover the risks, benefits, alternatives, experience and cost of the procedure (1190).  This document can facilitate discussion between physician and patient, and allow the patient to ask more questions and receive the doctor’s opinion. Consent forms will be standardized, and be at an average reading level and reasonable length (Krumholz 1190). Consent forms will not be written by the institution but by experts from the Department of Health and Human Services. One health system in Kansas City has tried out Krumholz’s solution, which led to “improved reading and satisfaction with the consent process, less patient anxiety, and a sense of partnership in the decision-making process” (1190). Krumholz’s solution agrees with one of the last points of Veatch’s article, “the concept of consent will have to be replaced with…active patient participation” (Veatch 327).

This change to patient-centered care could be added to current health care reform. President Obama’s Patient Protection and Affordable Care Act is attempting to improve health care by reducing the amount spent on health care and providing quality care that is affordable (Health Care Reform Timeline). Including active patient participation into the reform (or as a result of it) can also be beneficial. People may take a greater interest in their health, and could be more proactive in maintaining healthy lifestyles.

Sources

Health Care Reform Timeline. http://obamacarefacts.com/health-care-reform-timeline.php

Krumholz, H.M. “Informed Consent to Promote Patient-Centered Care.”  JAMA. 303.12 (2010):1190-1191. Web. 24 Feb 2014.

Veatch, R.M. Arguing about Bioethics. Ed. Stephen Holland. Routledge: New York, NY, 2012. Print.

Public Health and Respect for Personal Autonomy

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Applying ethical principles to the medical field has proven complex, as highlighted by James Childress in his writings on the complexities of adhering to respect for personal autonomy.[1] The philosophical discipline of bioethics is not narrowly tied to medicine, but expands to cover medical anthropology, medical sociology, health politics, health economics, research, public health policy, and more.[2] Public health aims at improving the health of the community as a whole, and public health initiatives usually involve preventative measures that prolong life and promote health. Generally, public health policy concerns itself with health based on population-level health analysis.  Thus, how do ethical principles change when the policy is focused on net benefit for the community, instead of focusing on individual community members?

Concentration on the group needs and health leads to thinking that often forgets about individual rights, but ethical principles of the individual need to be remembered when applying public health policies. Historically, individual rights are becoming increasingly recognized, and in the medical field, consent is a twentieth-century phenomenon.[3] As medicine increasingly recognizes individual rights, it is a logical extension for public health as a discipline to acknowledge analogous rights.

In bioethics, consent is rooted in the ethical principle of respect for personal autonomy, but this principle is complex and limited in application. Childress in “The Place of Autonomy in Bioethics” presents the scope of applicability of the principle of autonomy in medicine. He argues that first and foremost respect for autonomy of persons differs from people who are not autonomous such as children (unspecified age range) and the insane. Also, respect for autonomy must coincide with other necessary ethical principles such as beneficence and care, and in certain circumstances, ethical principles can outweigh or override one another. Thus, under certain circumstances the principle of respect for personal autonomy may be infringed upon, and specifically, the realm of public health needs to consider if policies made for the benefit of the group reasonably infringe upon the personal autonomy of group members.

The political cartoon depicts the modern-day anti-vacccination “epidemic.” This so-called epidemic is happening parallel to increasing focus on individual rights. Our generation will have to consider how much public health can infringe upon personal autonomy of our society’s citizens. (Source: http://theweek.com/cartoons/index/228275/the-anti-vaccine-epidemic)

This past September, 750 students in Winston-Salem, NC faced suspension after not adhering to state vaccination policies for the Tdap vaccination that protects against tetanus, diphtheria and whooping cough or pertussis.[4] Cases of mandatory vaccinations represent paternalistic interventions where interference with an individual’s liberty may be justified by reasons such as welfare, happiness, values, interests, and needs of the person being coerced. Mandatory vaccination initiatives are public heath measures that override rights of respect for personal autonomy for the sake of containing and preventing infection and disease. In context to this case, paternalism functions off the principle of beneficence. Mandatory vaccinations highlight the conflicts between moral principles, and under these circumstances, I think beneficence overrides each group member’s autonomy. While privacy and confidentiality can still be protected, controlling the spread of disease and preventing illness in community members is a moral call to action for vaccination. While it may be easier to fully respect the autonomy of an individual patient than an entire population, public health policy still should not deprive individuals of their rights without thoughtful consideration. Following Childress’s logic, are all group members considered equally autonomous thus infringement upon personal autonomy is the same? Or, based on group status does infringement on personal autonomy have different implications? In modern times, awareness of personal rights is increasing within bounds; therefore, it is important for public health to grasp and debate these ethical concerns. A new interpretation could view mandatory consent as a prior consent based on group membership, and thus interference is the price of group membership.[5]  Such a viewpoint believes that the individual’s interests are still considered, but an individual is accepting his or her role as a group member. Future public health policies could work to understand the line between respect for personal autonomy and social responsibility, and from there, public health can define its realm of action and control.

Sources:

[1] Childress, J. F. “The Place of Autonomy in Bioethics”

[2] Benatar, D. Bioethics and health and human rights: a critical view. Journal of Medical Ethics. 2006 January; 32(1): 17-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563274/

[3] Veatch, R. M. “Abandoning Informed Consent”

[4] http://www.journalnow.com/news/local/article_b770c0ca-2484-11e3-93a9-001a4bcf6878.html

[5] Hall, Spencer. Should public health respect autonomy? Journal of Medical Ethics. 1992. 18: 197-201.

Why is (Respect of) Autonomy Important?: Possible Cultural Preconceptions Surrounding the Argument for Autonomy

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When discussing biomedical ethics, we frequently favor the right of the patient to decide. This emphasis and respect for autonomy can overrule any number of other considerations. Therefore, I ask the following: Why is (respect of) autonomy important? A typical answer, and likely my own response, would include the importance of the individual’s right to make his/her own decisions. It is an exceedingly important component of any medical decision, and not to be taken lightly. The individual has final say because the body/mind in question is their own.

While reading J. F. Childress’ article “The Place of Autonomy in Bioethics”, I was struck by the potentially confounding factor of socioculturally different views on the importance of autonomy. As a product of American society, I have been raised to believe that the rights and privileges of the individual are paramount. Our culture and, indeed, most of Western thought, is centered on the idea that individuality (and the individual’s conception of that individuality) is to be encouraged. Given the dominance of Western thought in philosophical inquiry, particularly bioethical inquiry, it makes sense that a discussion of bioethics would take into consideration autonomy, the right of the individual to make his/her own decisions.

Free will is another Western presupposition that comes into play when discussing autonomy, the idea that we are the deciders of our own outcomes. Though I do not seek to undermine either of these ideas (free will and the importance of individuality), I think it is important to acknowledge and address the ways in which these ideas shape our dialogue. The reasoning behind the emphasis placed on autonomy is founded in the belief of both free will and individual importance. Should a society, religion, culture, etc. manifest a rejection of either of these principles, autonomy would, in that community, cease to be a worthwhile focus in bioethical conversation.

At the risk of bastardizing, oversimplifying, and/or misrepresenting my argument, I will lay out a general description of what I mean: If we reject the philosophical idea of free will, then our autonomous decisions (whether medical or not) become unimportant – free will is founded in self-determination and without it, predetermination negates the significance of choice. If we reject the sociocultural weight with which we measure individuality, if we cease to believe that the rights of the individual outweigh other considerations, then the value of the individual’s decision is called into question: if the individual is insignificant, why does their opinion and consequent decision matter?

Given that there exist many communities in the world in which one (or both) of these ideas is rejected, I believe reflection on the preconceived significance of free will and individuality under which we discuss autonomy is important to fully understand why our particular society and culture holds autonomy to be important. This type of reflection allows us to transcend our preconceived notions and the potential dangers that arise from not understanding or acknowledging our accepted cultural and philosophical biases.

In short, though I personally believe that a patient’s right to autonomy is exceedingly important, I must acknowledge that a) others- particularly those whose opinions have been shaped by different worldviews – may very well disagree with that opinion,  and b) my reasoning behind that opinion is founded in my own sociocultural and philosophical views on free will and the value of the individual.

Word count: 557

Works Cited:

Childress, James F. “The Place of Autonomy in Bioethics.” Arguing About Bioethics. By Stephen Holland. Hoboken: Taylor and Francis, 2013. Loc 8698-897. Kindle.

The Fight for Organ Donation

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organ-donation-logo

The Uniform Anatomical Gift Act (UAGA) authorizes the indication, either in a will or on a driver’s license, of a desire to donate one’s organs or body post mortem to act as a legal document. It is crazy to think that any form of legal documentation not be honored and upheld in American society, but apparently it is not uncommon for doctors or even the Organ Procurement Organization (OPO) to allow the family to act against the expressed wishes of the deceased. According to the UAGA, if a person has indicated their preference to be an organ donor, legally, the family has no say in the matter. So, why is such a decision, one made autonomously and ethically accepted as to be respected, so easily overruled at times? D. W. Donovan, a chaplain and vice president for mission and spiritual care at Providence Regional Medical Center in Everett, WA, claims that it is common practice to grant families the ability override previous declarations made by the deceased and offers three reasons for this in his article Defending the Donor’s Decision.

Although a doctor or OPO official have no legal reason to honor or even consider a family’s request to override the wishes of the deceased in regards to donating their organs, Donovan points out that it “can often leave medical personnel caught in the middle of an emotionally charged event” and put them in an awkward position when confronted by an “angry family member who is strenuously opposed to donation” (1). A study conducted in 2001 indicated that only 8% of OPO’s were likely to procure the deceased’s organs if the next of kin objected (1). Respecting a family’s overriding wishes, spares the doctor and the family member’s emotional distress presented by the situation.

Refusing to appease a grieving family member’s desire to keep their deceased love one “whole” or in-tact can have negative repercussions on the health facilities and is another reason that Donovan offers as to why we give in to family member’s requests. Although supporting a person’s decision to be an organ donor is an act of respect for the patient’s autonomy, it can be perceived alternately by the public as an “invasion of privacy and bodily integrity” and can result in poor public perception of that medical facility which is something that doctor’s would obviously want to avoid.

The third reason Donovan offers is that many regard a person’s choice to be an organ donor to not be an authentic autonomous decision. Miller’s article (that we read the other day) listed 4 qualifications for a decision to be regarded as autonomous: free action, authenticity, effective deliberation, and moral reflection. The choice to become an organ donor or not is made by checking a box at the DMV that literally just asks you if you want to be an organ donor. There is no explanation of what that entails, how the process works, how the organs will be procured, etc. Surely Miller would say that this is not a truly autonomous decision. Without any information about risks, benefits or alternatives to consider, how can one actively participate in effective deliberation even if it is a choice free of coercion and true to one’s generous disposition?

Are these common arguments enough to grant a family paternalistic authority over the body of a deceased loved one? I think it’s important to realize that emotions over the loss of a loved one often cause family members to act/think irrationally which certainly should at least prompt discussion of its own to determine whether decisions made in such emotional states can even really be consented to as autonomous.

 

1. http://www.chausa.org/publications/health-progress/article/march-april-2008/defending-the-donor’s-decision

Prisoners Health Care

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We have recently been speaking about access to health information and the responsibility of doctors to tell patients what they believe is important and what will cause unnecessary harm to the patient.
During this conversation I have been questioning the judgment call of doctors for certain patients. For example, if a doctor is forced to treat a patient they strongly dislike – will they give more or less care to the patient? Furthermore, would they unknowingly withhold information simply because they do not like the patient. Of course, we would like to assume that all patient treatment would be exactly the same but this of course is not true. Beyond the doctors’ control, the care will shift slightly for a patient they favor over a patient they dislike.

 

Although a bit of a leap, I began thinking about healthcare and health information in prisons in the United States. As we stress the importance of doctors’ gauge on a patients, health, needs and information; what about patients who doctors may have prematurely judged?

 

As of 2012, there were 1,517, 013 prisoners in the United States. Prisoners have the right to adequate healthcare under the eighth amendment. This means that prisoners should not be subject to cruel and unusual punishment. Clearly this is not the case. Many claims have been main regarding the “deprivation of basic elements of adequate medical treatment”, “deliberate indifference” and most importantly “abuse of discretion”.

 

Of the current inmates approximately 800,000 suffered from a chronic condition that needs regular medical attention such as diabetes, previous heart attacks and hypertension.  Furthermore the treatment rate for mental health ailments tripled for individuals after incarceration. With the Americans prison members older than 55 growing faster than the population at large, may prisons must be prepared to provide them healthcare. This will cost approximately nine times more than healthcare for younger inmates. As the prison population rises, hospitals for prisons are becoming overbooked such as in California, which currently has three hospitals. Prisons must then contract to private hospitals for inpatient care that can cost approximately $850,000 per year for one inmate.

 

It is a raising concern for many that healthcare costs in prisons are continually raising. As the U.S. healthcare suffers from severe budget crisis, prisoners are being moved to hospitals and additional forms of treatment. Doctors treating prisoners are often cited for ignoring patient needs or abusing the right of doctor discretion, a topic we have discussed at length.

 

Knowing this information, the current U.S. healthcare system and the large cost of incarceration it is crazy not to ensure that inmates get the basic care that they deserve. But is it really possible to ensure that they will be receiving ethical care? If prisoners are placed in private hospitals, will that not factor into treatment? Will they be given complete treatment, or treated like a general patient? Is it unethical to do so? How can we ensure that a doctor will be using sound discretion which treating these patients?

 

Sources:

Gardner, Amanda. “Many in U.S. Prisons Lack Good Healthcare.” HealthDay. Jan. 16 2009. Web

 

Klein, Stuart. “Prinsoners’ Rights to Physical and Mental Health Care: A Modern Expansion of the Eight Amendment’s Cruel and Unusual Punishment Clause.” Fordham Urban Law Journal. 1978.  N.pg. Print

 

Williams, Timothy. “Number of Older Inmates Grows, Stress Prisons.” New York Times. N.pg. Jan. 26, 2012. Web.

 

 

(Mis) Informed Consent: A Doctor’s Perspective

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Prior to having read some of assigned essays on informed consent, I believed it to be a relatively cut and dry issue. Many of the articles or videos that I have reviewed on informed consent seem for the most part repetitive. Informed consent is important—a good thing. Without policies that detail protocol doctors must follow in regards to their treatment of patients, who knows how a patient may be taken advantage of? After all “doctor knows best”; if the law does not stand to protect the rights of patient, who will? Should a patient be of sound mind and of age, they should be given full disclosure regarding the purpose of a medical procedure, the risks and benefits, probability of risk as well as alternatives to treatment (Brody, 283).  I am not a doctor and thus am only able to see things from the patient’s side of the informed consent debate. It seems simple, really. For a physician to balk at the idea of thoroughly briefing and obtaining permission regarding what happens to their patients’ bodies is ridiculous, right?

If informed consent is so great, though, why do so many physicians see it in many cases as unnecessary or frivolous? In the process of searching for interesting essays or articles on informed consent from a physician’s perspective, I stumbled upon a brief opinion piece by John Kelly IV, an MD who is a regular writer for Outpatient Surgery Magazine. Although the opinion was humorous, I think it did a decent job of shedding light onto the ways in which informed consent may be good in theory, but not in practice. Two of the problems that he focuses on in particular are “nitpicking” and “catastrophizing” (Kelly). The consent form is a legal document and of course important; however, how explicit do they really need to be? It is one thing to list possible risks for a certain procedure—that is for the patient’s benefit. But how detailed does a doctor need to be in describing a surgery that is a part of their daily routine? Forcing doctors to stress and go back over every word in a consent form is a waste of time and if anything, could cause them to lose respect for and patience in the process of informed consent.

The major issue that doctors seem to be concerned about when it comes to informed consent based upon my and other students’ posts seems to be “catastrophizing”: the idea that being too explicit in the risks of procedures, some of which are incredibly low, can lead to discouraging patients to receive the treatment and care that is essential to their health (Kelly). How much information is too much?

I am not at all saying that the cons of informed consent outweigh autonomy, which is the moral issue at the center of the argument. I do, however, believe that there should be a movement to standardize policy across states to make the issue a little less hazy for all involved as well as help to maximize the use of doctors’ time.  Solutions that I can think of include an official electronic database on which the risks of various standard procedures are outlined so that patients can clearly view the costs and benefits prior to giving consent. Another option would be to hire hospital staff or train current staff to specialize in patient relations; people who can to sit down with individuals and talk them through the risks and alternatives, as well as their doctor’s recommendations.  I am not sure what other solutions have been proposed or initiated; but until a larger solution is settled upon, the autonomy of the patient will continue to trump physician convenience and efficiency, and rightly so.

Citations:

Brody, Baruch A., and H. Tristram. Engelhardt. “Adult Patients: General Issues.” Bioethics: Readings Cases. Englewood Cliffs N.J: Prentice-Hall, 1987. 282-86. Print.

Kelly, John, IV. “Cutting Remarks: (Mis) Informed Consent.” Outpatient Surgery Magazine. N.p., Feb. 2014. Web. 17 Feb. 2014. <http://www.outpatientsurgery.net/outpatient-surgery-news-and-trends/humor-and-jokes/cutting-remarks-mis-informed-consent–02-14>.

Contradictory Choices

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The concept of complexity of respect for personal autonomy is quite complicated.  Autonomy in medical ethics is defined as, “the ability of the person to make his or her own decisions” (Autonomy-Wikipedia).  Several questions such as which request to abide by, and how to know if a patient wants full or partial disclosure are entirely debatable.  In more instances than not patients change their minds regarding treatments, and this brings about the question of which request do we follow?  Childress questions, “Which choices and actions should we respect?  In particular is it justifiable to override a patient’s present autonomous choices and actions in the light of his/her past or (anticipated) future choices and actions?” (Childress, 310)  This is the key question I am going to address in my argument.

When it comes to present versus past or future autonomy, Childress believes that the present autonomous statement is the one to listen to.  I both agree and disagree with parts of this statement.  Firstly, if one is in an autonomous state of mind and is able to make his or her own decisions, then their present statements should be considered.  However, if one’s present autonomous requests completely contradict previous requests I think past autonomous opinions should be weighted more heavily.  As well exampled in Childress’s argument , a woman who has been courageous about her treatment all her life who suddenly decides she wants to stop treatment is acting out of character.  Although this is her present autonomous request, it should not be the end- all- be- all decision, because the authenticity is questionable.

Authenticity is another important concept regarding contradictory choices and is defined as, “an action is consistent with the attitudes, values, dispositions and life plans of the person” (Childress, 311).  As the previous example portrayed, the woman’s authenticity was not intact, because her new rash opinion entirely contradicted what she had previously believed.  Childress also argues that, “it would be a mistake to make authenticity a criterion of autonomy.  At most, actions apparently out of character and inauthentic can be caution flags that warn others to request explanations and justifications to determine whether the actions are autonomous” (Childress, 311).  This, I disagree with, because authenticity should be considered when a new judgment is inconsistent with previous ones.  If a new opinion harshly contradicts years worth of beliefs then wouldn’t it make sense to more heavily consider prior opinions?  Although this is very contradictory, an inauthentic statement should not change everything, it should mean little because long-standing opinions and beliefs more accurately represent one’s true stance.  Another important point brought about by Levi in Respecting Patient Autonomy is that, “..in many cases present autonomous decisions conflict with the interest of preserving or promoting future autonomy, and one must choose between the two.  This situation is perhaps most pressing when autonomous are greatly imprudent and likely to compromise future well-being in addition to autonomy” (Levi, 83).  This statement entirely supports my argument because usually the inauthentic, imprudent judgments of patients that are inconsistent with their character greatly compromises their future well-being.  Overall, I believe that past autonomous decisions that represent years worth of beliefs and opinions should be considered more heavily than rash, present autonomous decisions.

Interesting link regarding Doctors not respecting autonomy and pushing their own beliefs:

Sources:

1.)http://en.wikipedia.org/wiki/Autonomy

2.) Arguing About Bioethics- Holland

3.) Respecting Patient Autonomy- Levi

4.) Pressing Patients to Change Their Minds- Lerner

A Right to Life

Uncategorized

          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).