Are decision making of doctors really beneficial for patients? Often patients give up all autonomy for the doctor’s perceived great knowledge of the health services. But as in all humans self-interest almost always clouds one decision on what is best. Terence Ackerman claims noninterference is bad because it does not consider effects of illness of a patient (Degrazia, Mappes, and Ballard 70-140) . Meaning that noninterference in regards to autonomy; makes the doctors job and decision very simple, “let the patient decide.” This is often a tragic case because most patients do not understand the consequences or benefits of a health decision or procedure. Thus why Edmund Pellegrino argues the central paradox in medicine is the tension between self-interest altruism, which means unselfishness (Degrazia, Mappes, and Ballard 70-140). Lying to patients for self-interest is an injustice on all levels and I will prove why.
In a recent and very disturbing case a doctor named Kermit Gosnell was doing abortions. One may ask, well what the big issue is. Yes abortions are a sad but common part of our society. Before I discuss the terms in how the abortions were carried out, I will disclose who he was helping. People in the West Philadelphia are part a very impoverished community. Dr. Gosnell catered to poor, immigrant, and minority women (Walters, and Dale ). So was he being the hero and savior to these women or doing an injustice? Dr. Gosnell’s procedures often consisted of late term abortions, which is after 23 weeks. Dr. Gosnell was performing abortions as late as 7 months. Often the procedure for late abortions is to dismember the body inside the uterus and remove by pieces. Dr. Gosnell was inducing labor and doing what he termed as “snipping.” After the babies were born he would cut open their necks and with scissors cut the spinal cord (Walters, and Dale ). And with Howard Browdy’s transparency model of informed consent there was a huge injustice to the patients. The transparency model consists of the physicians basic thinking is rendered clear or transparent. This is achieved through talking out loud with the patient and in a language or laymen terms for patient understanding. At least two women died from the procedures, while scores more suffered perforated bowels, cervixes, and uteruses.
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
According to Terrence F. Ackerman, as of the 1980s the American Medical Association had to include the respect for a person’s autonomy as a principle of medical ethics (Ackerman 14, 1982). This includes having the physician provide all the medical information to the patient even if the information could cause negative implication onto the patient. The physician is also expected to withhold all information of the patient from 3rd parties (Ackerman 14, 1982). Although it is seen as standard in today’s world, in
At first, I believed that a patient should have the say so and get what they demand. I didn’t feel sympathetic for the health care provider one bit. I was able to look through the eyes of a physician and see the trials that they have to go through. It is not easy making the decisions that they have to make. There job is based on decisions, and most of it is the patient’s. “There will certainly be times when I will be faced with a request from a patient or patient’s representative that I will personally find morally difficult, but one that is still legally and ethically acceptable. must be very difficult to work in an area with little control over what you want to do.” (Bradley 1). Even though I do not fully understand a health care providers everyday role, I do know that they are faced with painful options. I personally feel that I can not work in this field for that exact reason. Health care providers play an extremely important role in our society, and others need to look upon
Principles of Biomedical Ethics, by Tom Beauchamp and James F. Childress, has for many critics in medical ethics exemplified the worse sins of "principlism." From its first edition, the authors have argued for the importance and usefulness of general principles for justifying ethical judgments about policies and cases in medical ethics. The organization of their book reflects this conviction, dividing discussion of particular ethical problems under the rubrics of the key ethical principles which the authors believe should govern our moral judgments: principles of autonomy, nonmaleficence, beneficence and justice.
The author explains how randomized clinical trials put physicians in ethically intolerable positions of choosing between the good of the patient and that of society. A kantian argument is formed when the author explains how the physician has the duty to tell the truth and not use the patient as a mere means to satisfy the needs of a majority. The well being of the patient is far more important than that of the society when it comes to treatment by personal physician, the Author suggests that there should be alternatives to randomized clinical trials to deal with observer bias and patient selection. The overall message of the article stresses the importance of a patient’s well being over the well being of a society because the physician has the duty to help the patient improve his/her health.
This freedom of choice, Gawande states, ultimately places a burden on either the doctor or the patient as the patient ultimately choose a course of treatment that is ultimately detrimental as in the case of Lazaroff, a patient with only a few weeks to live, but rather insist on “the day he would go back to work.” Despite the terrible risks and the limited potential benefits the neurosurgeon described, Lazaroff continued to opt to surgery and eventually died painfully as a result of surgery. Gawande suggests that Lazaroff “chose badly because his choice ran against his deepest interests,” which was to live despite his briefing remaining time, ultimately distorting his judgement into choosing a course of treatment that ultimately ended his life in a much more painful manner. Another case of patient decisions that Gawande discusses is Mr. Howe, who aggressively refused to be put on a breathing machine, neglecting the fact that “with antibiotics and some high-tech support...he would recover fully.” As Gawande and K awaited for Mrs. Howe’s decision to save her husband’s life, Mrs. Howe emotionally breaks down
Providers must act in the best interest of the patient and their basic obligation is to do no harm and work for the public’s wellbeing. A physician shall always keep in mind the obligation of preserving human life. Providers must communicate full, accurate and unbiased information so patients can make informed decisions about their health care. As a result of their recommendations, providers are responsible for generating costs in health care but do not generate the need for those expenses. Every hospital has both an ethical as well as a legal responsibility to provide care, even if the care may be uncompensated.
Alan Goldman argues that medical paternalism is unjustified except in very rare cases. He states that disregarding patient autonomy, forcing patients to undergo procedures, and withholding important information regarding diagnoses and medical procedures is morally wrong. Goldman argues that it is more important to allow patients to have the ability to make autonomous decisions with their health and what treatment options if any they want to pursue. He argues that medical professionals must respect patient autonomy regardless of the results that may or may not be beneficial to a patient’s health. I will both offer an objection and support Goldman’s argument. I will
In his essay, “The Refutation of Medical Paternalism,” Alan Goldman discusses his argument against differentiation in the roles between physicians and patients. He says the physician may act against a patient’s will in order treat the patient in their best interest. Goldman makes his whole argument around the assumption that a person’s right to decide his or her future is the most important and fundamental right, saying, “the autonomous individual is the source of those other goods he enjoys, and so is not to be sacrificed for the sake of them.” His claim is that most people agree that they are the best judges of their own self-interest and there is an innate value in the freedom to determine their own future. On these principles, Goldman starts by discussing conditions under which paternalism may be justified.
The delivery of healthcare mandates a lot of difficult decision making for healthcare providers as well as patients. For patients, much of the responsibility is left to them especially when serious health problems occur. This responsibility deals with what treatments could be accepted, what treatments could be continued, and what treatments could be stopped. Overall, it considers what route should be taken in regards to the health interests of the patient. However, there are circumstances in which patients cannot decide for themselves or communicate what they want in terms of their healthcare. This is where the ethical issue concerning who should be responsible for making these important healthcare decisions occur if a patient was to be in this sort of situation. Healthcare providers can play a role in the healthcare decision making as their duty is to act in the best interest of the patient.
Personal autonomy refers to the capacity to think, decide and act on one's own free initiative (Patient confidentiality & divulging patient information to third parties, 1996). For a patient’s choice to be an autonomous choice, the patient must make his choice voluntarily (free of controlling constraints), his choice must be adequately informed, and the patient must have decision-making capacity (he must be competent) (Paola, 2010), therefore Physicians and family members should help the patient come to his own decision by providing full information; they should also uphold a competent, adult patient's decision, even if it appears medically wrong (Patient confidentiality & divulging patient information to third parties, 1996).
In the realm of medical ethics, there are many topics that are debated and discussed, but there is not necessarily one clear, correct answer. One of these topics is paternalism. Many questions are bandied back and forth: is it beneficial, should it be disallowed entirely, are there instances when paternalism is good and beneficial, and the list goes on. For each of these questions there have been authors who have provided their comments. One such author is Alan Goldman. He draws a very firm line on paternalism, simply put: medical paternalism is deleterious to a patient because it intrudes on their primary rights of liberty and autonomy. This paper is going to expound upon Goldman’s viewpoint in detail, going through point by point how he presents his argument. There will then be a critique of Goldman’s viewpoint that will counter his main points. The counterpoints will show Goldman’s views on paternalism are incorrect and should not be considered valid.
Patient participation has been poorly defined especially in nursing practice due to lack of freedom from indistinctness or ambiguity in health care (Sahlsten, Larsson, Sjostrom, & Plos, 2008). The concept of patient participation plays an important role in health care nationally and globally. The meaning of patient participation varies greatly based on individual patient and nurse’s perception. This concept analysis it to gain clarity through Walker and Avant concept analysis method by identifying and presenting the purpose, attributes, model case, antecedents, consequences and empirical referents of the concepts.
The writer asserts that, although the doctor upholds the dignity of oaths by preventing or terminating any harm towards the patient, equally important is assessing the possible benefits and drawbacks of any treatment. Therefore, it is vital to discuss the principle of beneficence under two subheadings, positive beneficence and the utilitarian principle (Beauchamp, 1989, p.195).
Consequently, it can be assumed that doctors might tend to avoid such a confession in order to maintain their image of being a “good doctor” (J.Shahidi). Not being a good doctor may eventually lead to doctor’s loss of business and as a result physicians may tend to hide the truth even if it opposes patient autonomy