Autonomy Vs Paternalism Essay
In the medical field there emerges a conflict that all physicians will eventually come to deal with, or are already dealing with regularly; that is the conflict of Autonomy and informed consent versus Paternalism and the doctor's intervention. In one hand, Autonomy is the principle of non-interference and the right to self-governance; informed consent is the concept that "Every human being of adult years and sound mind has a right to determine what shall be done with his own body
(102)" it is the exercise of a choice after being informed of the process and risks of a medical treatment. While in the other hand lies Paternalism; "the interference with, limitation of, or usurpation of individual autonomy justified by reasons referring exclusively
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to the welfare or needs of the person" being overridden (61). In other words: doctor knows best, doctor chooses best, doctor does best- all for the welfare of the doctors patient.
Taking a closer look at Autonomy we see that there are some obstacles that might become involved. First, by definition, it must involve a human of "adult years," and a "sound mind." This brings in some constraints that need to be addressed, other then the obvious age constraint. Terrence Ackerman in his report dated 1982 called "Why Doctors should intervene" gives light to various kinds of constraints. These include: Physical constraints; such as prison or bodily prevention, Cognitive constraints; someone with the inability to understand the information given to them, Psychological constraints; this would involve someone who is depressed or suffers from something like Alzheimer's disease, and Social constraints; a peer pressure or the cultural background of a patient playing a role in autonomous decisions. Considering the previous constraints from Ackerman's report, the answer is paternalism. When a patient has one or more of these constraints, the best way to make a decision concerning the welfare and needs of a patient is to allow the doctor to intervene, but this intervention must only be "justified by reasons referring exclusively to the welfare or needs of the patient" (61). The transparency standard is a
standard that promotes patient autonomy it "requires the physician to engage in the typical patient management thought process, only to do it out loud in a language understandable to the patient" (115). In other words, the doctor must completely inform the patient, to the best of his ability, about everything; risks, procedures, situations, and allows patient to ask questions about any and/or all of these. But this standard still has the constraints that were listed earlier, you can "inform" a patient as much as possible, but if they aren't competent enough to comprehend the information or are being pressured into making decisions, then the questions must be asked: is it truly an autonomous decision? And is it even possible to not be "constrained?" In the end, some form of paternalistic action, with a respect to autonomy of the patient (who fits the criteria of a competent and non-constrained person), seems to be the best choice. In most cases, given the fact that the doctor informs his patient, the doctor usually knows best. Even when the doctor knows the best, it doesn't always mean he should act on it. Other things become involved in the patients' decision making, such as Religious beliefs, cultural background, or tradition. Ruth Macklin, in her article Ethical Relativism in a Multicultural Society, says that:
There are rarely good grounds for failing to respect the wishes of people based on their traditional religious or cultural beliefs. But when beliefs issue in actions that cause harm to others, attempts to prevent those harmful consequences are justifiable.
This would mean when a patient refuses treatment because of a religious belief a doctor must respect that patient's autonomous decision, but why is this not considered a type of constraint? One possibility is the fact that a religion (any form of belief system, by definition) is something chosen and accepted by one's own faith, it is not something physical or a sign of one who is cognitively impaired. When these beliefs, according to Ms. Macklin, cause harm to others is the only time when intervention is justifiable; such as the Santerian ritual of scattering of poisonous mercury to ward off bad spirits that bring poor health. When a physician is aware of the beliefs and culture of a patient and the patient "informs" the doctor of these beliefs, conflict can be avoided. The doctor should respect the patient's autonomy. Enacted in 1990, the Patients Self Determination Act (PSDA) ensures that the hospital/healthcare provider informs patients of the medical procedures and their right to specify whether or not they chose to accept or refuse specific medical treatment. It also guarantees that they will be informed of the right to identify a legal representative for an unforeseen or urgent medical decision that must be made, and if by reason of illness the patient is unable to make decision for medical treatment, proper documentation has already been made concerning the patients wishes. The PSDA promotes a patient's autonomy and allows the wishes of a patient to be properly accommodated. No healthcare or patient situation is the same, there is no one size fits all answer' when it comes to patient autonomy and doctors intervention. Respect for patients autonomy is something that must be carefully considered.
to the welfare or needs of the person" being overridden (61). In other words: doctor knows best, doctor chooses best, doctor does best- all for the welfare of the doctors patient.
Taking a closer look at Autonomy we see that there are some obstacles that might become involved. First, by definition, it must involve a human of "adult years," and a "sound mind." This brings in some constraints that need to be addressed, other then the obvious age constraint. Terrence Ackerman in his report dated 1982 called "Why Doctors should intervene" gives light to various kinds of constraints. These include: Physical constraints; such as prison or bodily prevention, Cognitive constraints; someone with the inability to understand the information given to them, Psychological constraints; this would involve someone who is depressed or suffers from something like Alzheimer's disease, and Social constraints; a peer pressure or the cultural background of a patient playing a role in autonomous decisions. Considering the previous constraints from Ackerman's report, the answer is paternalism. When a patient has one or more of these constraints, the best way to make a decision concerning the welfare and needs of a patient is to allow the doctor to intervene, but this intervention must only be "justified by reasons referring exclusively to the welfare or needs of the patient" (61). The transparency standard is a
standard that promotes patient autonomy it "requires the physician to engage in the typical patient management thought process, only to do it out loud in a language understandable to the patient" (115). In other words, the doctor must completely inform the patient, to the best of his ability, about everything; risks, procedures, situations, and allows patient to ask questions about any and/or all of these. But this standard still has the constraints that were listed earlier, you can "inform" a patient as much as possible, but if they aren't competent enough to comprehend the information or are being pressured into making decisions, then the questions must be asked: is it truly an autonomous decision? And is it even possible to not be "constrained?" In the end, some form of paternalistic action, with a respect to autonomy of the patient (who fits the criteria of a competent and non-constrained person), seems to be the best choice. In most cases, given the fact that the doctor informs his patient, the doctor usually knows best. Even when the doctor knows the best, it doesn't always mean he should act on it. Other things become involved in the patients' decision making, such as Religious beliefs, cultural background, or tradition. Ruth Macklin, in her article Ethical Relativism in a Multicultural Society, says that:
There are rarely good grounds for failing to respect the wishes of people based on their traditional religious or cultural beliefs. But when beliefs issue in actions that cause harm to others, attempts to prevent those harmful consequences are justifiable.
This would mean when a patient refuses treatment because of a religious belief a doctor must respect that patient's autonomous decision, but why is this not considered a type of constraint? One possibility is the fact that a religion (any form of belief system, by definition) is something chosen and accepted by one's own faith, it is not something physical or a sign of one who is cognitively impaired. When these beliefs, according to Ms. Macklin, cause harm to others is the only time when intervention is justifiable; such as the Santerian ritual of scattering of poisonous mercury to ward off bad spirits that bring poor health. When a physician is aware of the beliefs and culture of a patient and the patient "informs" the doctor of these beliefs, conflict can be avoided. The doctor should respect the patient's autonomy. Enacted in 1990, the Patients Self Determination Act (PSDA) ensures that the hospital/healthcare provider informs patients of the medical procedures and their right to specify whether or not they chose to accept or refuse specific medical treatment. It also guarantees that they will be informed of the right to identify a legal representative for an unforeseen or urgent medical decision that must be made, and if by reason of illness the patient is unable to make decision for medical treatment, proper documentation has already been made concerning the patients wishes. The PSDA promotes a patient's autonomy and allows the wishes of a patient to be properly accommodated. No healthcare or patient situation is the same, there is no one size fits all answer' when it comes to patient autonomy and doctors intervention. Respect for patients autonomy is something that must be carefully considered.