Severe Illnesses: A Case Study

In the case of severe illnesses, I believe a blend of medical paternalism and patient autonomy would allow for the best treatment for the patient. Severe illness, for the sake of this paper, can be described as physical or psychological pain that greatly affects the quality of life for the patient with said illness. Medical paternalism is the overriding or restricting of a patient’s rights for their own good. Patient autonomy can be defined as a patient’s self governed choice that reflects their beliefs and values.
In order to illustrate, I will provide a case study as to how a combination of medical paternalism and patient autonomy could be used as the best treatment option. Jessica, a 25-year-old mother of a 3-year-old daughter, is currently in recovering from Anorexia, an eating disorder in which an individual obsesses over their weight, image, and the amount they eat. Jessica has been diagnosed with
stage 4 breast cancer, in which I, the doctor, believe will soon be metastatic if chemotherapy is not done right away after surgery. Jessica fears doing chemotherapy as she explains there is a possibility she may gain drastic weight or lose drastic weight, which would affect her psychosis during recovery. In Jessica’s case, she is severely ill, but the treatment I recommend has a possibility of her wanting to relapse back to Anorexia.
One might think that Jessica’s decision making abilities are clouded and that I should use medical paternalism for her own good. Another option would be to respect Jessica’s autonomy and not treat her cancer in order for her to recover from the eating disorder. Though, I believe the best treatment option would be to use a combination of medical paternalism and patient autonomy. In my role as a physician, reflecting on the modern Hippocratic oath, it is my job to care for my patients through humility, compassion, and honesty. I will work with Jessica in understanding her values and what ultimately she feels is best for her. Jessica has suffered from a psychological disorder, but this does not cloud her judgment, rather she requires a more unique style of care than the average individual. Symptoms are generalizable, but treatment cannot be due to the multitude of psychological, cultural, and social influences that affect every
patient.
If she concerns relapsing, I, as her care provider, should take the time to understand how much that means to her to gain or lose weight drastically. I then should honestly inform her on all treatment side effects and the true likelihood of it affecting her weight. If Jessica makes the autonomous choice of trying the treatment and she does end up having weight fluctuations, and she is unhappy with her care, I should work with her to start a new treatment plan that best comforts her. If Jessica decides not to take the treatment due to the risk of weight fluctuation, I should respect her decision, but I should not give up on her. My job then is to work with her to find a treatment option that best works for her so that I still may fulfill my duties as her healer. We could try natural remedies to lessen her pain, or perhaps, a combination of chemotherapy and behavioral therapy to aide her during possible relapse. In regards to her daughter, I cannot make decisions for Jessica, even if I do worry for her daughter growing up without a mother. As a resource to my patient, I can connect her to services, such as social workers, to work out future care plans for her daughter if she did choose to decline treatment. At the end of the day, Jessica knows her body and her values better than anyone, as her care provider my main job is to create a treatment plan that best works for her.