Autonomy v/s Paternalism
The Patient Self-Determination Act of 1990 (PSDA) was created to ensure that patients have the right to be a part of the medical team and have active role in setting up goals related to their plan of care. Patients have a right to autonomy or respect of their health care wishes. Many times the patient’s decision may conflict with what the healthcare provider thinks is the best course of action. Paternalism is when a health care provider interferes with a patient’s ability to make their own healthcare decisions (American Nurses Association, n.d.). For example, this may involve the withholding of information that may make a patient decide against a course of action that the health provider feels is the best course
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The homecare nurse failed to access the family unit as a whole. Family assessment should have involved consideration of education levels, health problems, family demographics and psychosocial problems (T. O’Hara, personal communication, August, 2015). The nurse just assumed Mrs. H was able to help with Mr. H’s wound. While her diabetes and ill appearance is noted, the home care nurse failed to access if Mrs. H health problems would prohibit her from providing appropriate care to her husband. The nurse also never observed Mrs. H performing Mr. H’s wound and did not know she was performing the wound care correctly. Mr. and Mrs. H also have a mentally handicapped son and there is not mention to his functioning level and how much care he requires. Perhaps Mr. H was so consumed with his son’s needs that he was unable to see that he needed help too. It this writer’s belief that both the nurse and family doctor saw the H family has dysfunctional, and did nothing investigate why they were dysfunctional. While the family did exhibit signs of dysfunction discussed in the lecture such as non-compliance and resistant to make necessary changes, nothing is done to help the family overcome any barriers to Mr. H getting the care he needs (T. O’Hara, personal communication, August, 2015). The nurse also provided no teaching to Mrs. H whom Mr. H had appointed as a caregiver, nor did she access her ability to perform the required wound care. The nurse also did access the roles within the family. Diet is a huge factor in Mr. H’s health maintenance, yet the nurse failed to access who was responsible for food preparation and shopping. For example teaching Mr. H about nutrition is not very effective if he is not the one preparing
“Patient advocacy is a process that involves a series of actions, behaviors and/or practices for preserving and safeguarding the rights, values, wellbeing and best interests of patients in the healthcare system” (Vaarito et al 2006, Bu and Jezewski 2007, Zomorodi and Foley 2009). Vaartio & Leino-Kilpi describe patient advocacy into two sectors; proactive advocacy and reactive advocacy (2004). Proactive advocacy includes actions aimed at aiding the patients in informed decision making and the protection of patient rights; reactive advocacy is focused on addressing safety concerns (Vaartio & Leino-Kilpi, 2004). Further concept analyses from Baldwin 2003 & Bu and Jezewski 2007, include four main sectors of patient advocacy: Protecting and empowering patient autonomy, protecting and representing the best interests of vulnerable patients, ensuring educated decision making while acting as a mediator for the patient to healthcare services, and lastly acting upon social justice to help create equitable access to adequate healthcare (CPD, 2015). Using Tanners model of clinical judgment; the process of patient advocacy begins with assessing for the need to advocate. The assessment should include the patient, environment, situation, resources and possible risks (Ellis
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
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
The main reason paternalism is even debated revolves around one primary question: Is it beneficial to the patient? This one question has, and will continue to evoke strong responses from those who hold viewpoints across the spectrum. The spectrum varies from those who are in favor of paternalism, to those who think it should only be allowed if certain criteria are met, to those who strongly oppose it in any form at any time, but may consent to a few, rare occasions when it would be deemed acceptable. One such person who strongly opposes paternalism is Alan Goldman, and he presents his argument in an article entitled, “The Refutation of Medical Paternalism.”
In this context, new emphasis is being placed on the rights of patients. Recent federal legislation, for example, requires all health care facilities receiving Medicare or Medicaid monies to inform patients of their right to make medical treatment decisions. This includes the right to specify "advance directives," [1] which state what patients wish to be done in case they are no longer able to communicate adequately.
Patients are ultimately responsible for their own health and wellbeing and should be held responsible for the consequences of their decisions and actions. All people have the right to refuse treatment even where refusal may result in harm to themselves or in their own death and providers are legally bound to respect their decision. If patients cannot decide for themselves, but have previously decided to refuse treatment while still competent, their decision is legally binding. Where a patient's views are not known, the doctor has a responsibility to make a decision, but should consult other healthcare professionals and people close to the patient.
The Declaration of Independence, written by Thomas Jefferson (with the help of Benjamin Franklin, John Adams, as well as many others), was signed on July 1st, 1776 in Philadelphia. Thomas Jefferson wrote the Declaration of Independence to appeal to the British Parliament and King and explain why the American Colonies wanted independence from England. Thomas Jefferson and the other delegates from the Second Continental Congress agreed that, “all men are created equal, that they are endowed by their creator certain unalienable rights” (p. 112) which became the base for nearly all of the points made in the document. Logical and emotional statements were used throughout the document to make impactful statements that would convince the audience of the seriousness of the matters they were presenting.
his own life how he wishes, even if it will damage health or lead to
There was inappropriate staffing in the Emergency Room which was a factor in the event. There was one registered nurse (RN) and one licensed practical nurse (LPN) on duty at the time of the incident. Additional staff was available and not called in. The Emergency Nurses Association holds the position there should be two registered nurses whose responsibility is to prov...
As the EAI team was discussing Molly’s case, one of the ED Residents made a few telephone calls. Molly’s PCP reported that during her last visit about 2 weeks ago, Mollie was alert and able to respond to questions appropriately. He confirmed that Mollie’s daughter and son in law have experienced psychiatric problems, adding that the son in law has expressed anger regarding Mollie’s living arrangements. The home health care agency was contacted. The RN and aide both report they have never met the son in law and have had very limited contact with Mollie’s daughter. When contacted by telephone, the daughter provided no explanation for Mollie’s extensive bruises noted on admission to the hospital. The daughter stated that Mollie did not fall, but in fact lowered herself to the floor in an effort to draw
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
...and medical power of attorney choices. Under the Patient Self-Determination Act of 1990, healthcare providers ask their patients about advance directives and provide information about available directives, enabling a conversation to take place between them.
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.
As nurses, it is important that we “be both empowered and competent enablers of patient empowerment.” (Burkhardt & Nathaniel, 2014, p. 493) We take an oath to follow an ethical code which requires us to act as our patient’s advocate while providing safe nursing care. Nevertheless, we cannot make any medical choice or decision on their behalf. We also cannot empower them, “because to do so removes the element of choice.”