Autonomy in Medicine
Written by Cara Chang
Edited by Adnan Prantoi
Physicians are trained to make important decisions about their patients. As professionals, they have an ethical obligation to act in their patients' best interest and simultaneously minimize any pain or suffering for the patient. In 1914, chief justice Benjamin Cardozo wrote regarding autonomy, saying that "every human being of adult years and sound mind has a right to determine what shall be done with his own body and a surgeon who performs an operation without his patient's consent commits an assault for which he is liable in damages." Today in our community, patients expect doctors to provide them and their families with all the information regarding the patient's condition. Decisions about the patient's care are decided by the patient and both the patient and their family at times. However, in many Eastern societies, doctors meet with the patient's family members to discuss the care of the patient without involving the patient. Families decide if the patient should be informed about the diagnosis and treatment plans. Doctors and family members are concerned that the stress and anxiety caused by knowing about the condition may hinder the patient's recovery and mental health. For example, in the movie The Farewell, the dilemma facing the modern-day Wang family is how to keep the grandmother from knowing her cancer diagnosis. Though the grandmother is facing a severe illness with a poor prognosis, the family goes to extensive lengths to keep her remaining days on earth as happy as possible. They do this by planning an elaborate but phony wedding to bring members of the extended family together so that the grandmother may see them for one last time.
The purpose of this is not to convince anyone that one approach is superior to the other. Instead, I present two approaches to patient care and state the care of patients. Doctors not only have to treat their patients and avoid harming them, but they must also consider providing culturally sensitive care to maintain a trustworthy relationship. Family plays a vital role in the care of patients. For Western families, unless the patient is incompetent, they have the final say on their medical care, and doctors will follow those wishes. The patient makes a decision based on what they believe to be objective and beneficial to themselves. For example, a doctor might directly contact a patient regarding a serious diagnosis and present possible treatment options from which the patient will choose.
The practice of medicine in today's society must remember that patients come from different geographic regions and cultural backgrounds. In Eastern cultures, patients seek the advice and counsel of family members instead of making a solo decision regarding their medical care. Patients care about the opinion of family members, and it is the family's responsibility to take care of a sick member. Doctors may seek treatment consent from family members, not just listen to the patient's wishes. In Eastern cultures, a family is a single unit in society. Their decisions will consider what is good for the family and not only what is suitable for the patient. A classic instance of this would be the doctor directly contacting a patient's family regarding a serious diagnosis and presenting possible treatment options from which the patient's family will choose. Overall, one of the fundamental principles of ethics is autonomy; respect for a patient's autonomy is the cornerstone of the practice of medicine. How do physicians and other healthcare providers think about patients' autonomy when practicing in today's society without violating this fundamental principle of bioethics?
Varkey, Basil. “Principles of Clinical Ethics and Their Application to Practice.” Medical Principles and Practice, vol. 30, no. 1, Feb. 2021, pp. 17–28, https://doi.org/10.1159/000509119. Freeman, Greg. “1914 Case Established Informed Consent Principles.” Www.reliasmedia.com, 1 Oct. 2019, www.reliasmedia.com/articles/145095-case-established-informed-consent- principles.
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