Patient Autonomy And Physician Beneficence -Myassignementhelp.Com

Question: Discuss About The Patient Autonomy And Physician Beneficence? Answer: Introducation Ethics are the values which guide the actions of the individuals, and are based on the morals of such individual. These morals and values channel the acts undertaken by the people. These ethics translate in the daily lives of people and decide upon the manner in which a person acts. Naturally, these also shape the manner in which the work is done by the individuals (Smith, 2008). When it comes to healthcare, the role of the individuals, in adhering to the ethical values in enhanced. This is because the relationship between the patients and the healthcare professionals is one of trust and care; and due to the dominating position of the healthcare professionals over their patients and the ones related to the patients, it becomes utmost important that the ethics are properly followed. This is particularly due to the patients having certain rights in the kind of treatment they get and the duty of the healthcare professionals to respect the human rights of their patients. One of such righ ts is autonomy, where it is stated that the patients need to have the freedom of deciding upon their lives, which includes the medical treatment they get, and the like. However, a controversial issue in this regard is offered through the concept of paternalism. This concept provides that there should be the right with the healthcare professionals to interfere in the liberty of actions of an individual owing to their welfare, happiness, interests, values, or good (Murgic, et al. 2015). The difference between the two, in terms of healthcare ethics is elucidated below. Along with the clash between the two concepts, the discussion would also highlight the significance of consent and confidentiality in context of healthcare. The overall purpose here is to highlight the key points which are related to healthcare ethics. Consent, or is aptly known as informed consent, in context of healthcare industry, is referred to the permission given by the individual, after they come to know about all of the facts of the case and the possible consequences of undertaking such actions. In doctor-patient relationships, informed consent holds major significance as the patients are required to be given the entire facts of their case and the possible results of their treatment, in order for such patient to given their informed consent to a particular treatment. This allows the patients to analyse all the facts and weigh in the pertinent risks, before they opt for a particular treatment suggested by the healthcare professional (Wear, 2012). This consent is based on the clear understanding, as well as, on the appreciation of factual background, its implications, and the consequences of going forward with the proposed action. Particularly in context of ethics, a proper and informed consent has its roots in the dignity of any individual. This means that the people need to be provided with the adequate reasoning facilities for them to give their consent on the basis of the facts which are relevant to them (Brown, 2011). The concept of consent is based on the basic human rights and on the ethical principle of patient autonomy. The patients have all of the freedom in order to make a decision on what happens to their body and for gathering the relevant information before a surgery, test or procedure is undertaken. A patient cannot be coerced in any manner; the doctors simply have to act as the facilitator of the decision making of the patients. Consent is not only stemmed in ethical principles, but in the legal ones as well. Where the informed consent of the individual is not taken, and the patient is touched by the doctor, it would be treated as battery, which is a physical assault in legal terms, and is also punishable. This makes taking of the consent very crucial in the daily physical examinations. This makes the mutual communication between a patient and doctor instrumental in context of the choice, authorization or permission of the former for acting the latter in a specific manner (Rao, 2008). Another crucial element related to consent is the difference between an implied and express consent. The implied consent, as the name suggests is one which is implied through the conduct of the patient; and the express consent is the one procured expressly from the patient. The difference between the two can be better elucidated through respective examples. When a patient goes in the chamber of the doctor and they express their problems to the doctor, there is an implied consent to the doctor for undertaking the general physical exam and for carrying the routine investigations. However, when it comes to the express consent, the same is needed for intimate examinations. For instance, where an invasive test or a risky procedure is to be undertaken, a specific express consent has to be taken from the patient, which can take form of written consent or oral consent (Snyder and Leffler, 2005). It remains preferable to take written consents in such cases where long term follow up is require d, in addition to the procedure being high risky intervention, surgery or cosmetic procedure. In order to gain the informed consent of the patient, crucial information has to be disclosed which involves the need for further testing, the condition of patient, results of treatment, different available options, possible complications, expected outcome, duration and cost of treatment, and the possible benefits and risks of such treatment (Heywood, Macsakill and Higgins, 2010). The concept of consent is also aligned based on the ECHR, i.e., the European Convention on Human Rights. Under article 3, it is specifically provided that a forced treatment which is given against the wishes of an individual would be deemed as the breach of this article, as this article is related to the inter alia inhumane and degraded treatment (Byrne, 2012). In Ireland, the patient doctor relationship is deemed as a privileged one and is dependent on the trust of the patient in professional conduct of the doctor. This is the reason for issuing a Guide to Professional Conduct and Ethics by the Medical Council for the registered medical practitioners (Medical Council, 2018). Another important concept in health ethics is autonomy v paternalism. Patient autonomy is the basic principle in the concept of professional medical ethics. The ability of recognizing and fostering the same has different dimensions and has been considered of vital significance in the clinical competency of the physicians. Beauchamp and Childress (2001) accepted autonomy as amongst one of the four principles of medical ethics, in addition to justice, beneficence and non-malfeasance. As stated in the introductory segment, autonomy is related to the self-determination or the self-rule, where the patient gets to decide on the treatments they get in a free and independent manner (Tai and Tsai, 2003). Paternalism on the other hand, is just the opposite of autonomy, where the doctors are said to act as the moral agent of the patients and make the best decisions for the patients, even when they can make such decisions for themselves. This is stemmed from the fact that the doctors are experts who can easily make the judgments and decisions as they know what has to be paid attention to and what has to be ignored. This brings forth an ethical dilemma for the healthcare professionals, where they have to choose between providing the patients with the requisite autonomy or giving the doctors the paternalistic freedom of choosing what is best for patients (Lepping, Palmstierna and Raveesh, 2016). In medical ethics, it is necessary to give more significance to paternalism in place of autonomy. To prove this, an example is put forth here. A 32 year old pregnant lady went for a vaginal delivery. Before this pregnancy, she had two babies through emergency caesarean section. And the second baby had been born merely one year ago. As a result of this, the doctors wanted the wide to avoid taking any sort of risk and wanted her to deliver the baby through a caesarean section. Both the husband and the wife were attempted to be convinced by the medical staff; however, they did not agree with the same. As a result of this, the patient was sent back home in order for trail of normal labor. After a period of two weeks, she returned to the hospital with very strong pains and when his delivery was taking place the uterus was ruptured. The doctors were able to deliver the baby in a normal manner but the mother had to be transferred to Intensive Care Unit in order to observe her closely. Howev er, she could not be saved and died a few weeks later (Sayani, 2015). This case helps in raising certain good questions. The very crucial one is whether medical paternalism could have saved the life of the patients? And whether in this case the principle of autonomy was justified? This highlights the ethical dilemma where respecting the autonomy of the couple, the women was exposed to complications, which ultimately resulted in her demise. Had the healthcare professionals taken the decision, there would have been a breach of autonomy of the patient. To put emphasis on paternalism, another example can be put forth. This is the case of suicide, particularly in cases of individuals suffering from psychiatric illness. An individual suffering from psychiatric illness, particularly who are at the risk of committing suicide, cannot be given their autonomy. If the autonomy is given to such patients, they would commit suicide. Even though this could be deemed as giving the individuals the freedom of making their own choices, it would not be ethical on part of t he doctor to allow the patient to be given their autonomy when they know this would result in the patient killing themselves. This is where the fight between the two concepts of autonomy and paternalism takes place. This is the situation where the healthcare practitioners face the ethical dilemma of choosing between the two concepts (Ho, 2014). In this regard, when psychotherapy is performed by the psychiatrists, they initially have the tendency of withholding certain information from their patients. An example of this is that they would not tell their patients the psychodynamics which they infer. In place of this, the information is titrated over a course of time. This is to safeguard the patients from getting overwhelmed and from not returning to get the relevant treatment, which is important for them. However, there are psychiatrists who feel that full information should be shared with the patients and that the patients should be given the time to share this information, even when doing so results in greater harm being caused to the patients. In terms of ethics, the reasoning for sharing of information with the patients could be justifiable and even obligatory in context of increasing their autonomy. This is deemed as more important value in general in place of attaining benefit for the patient by withholding such inform ation from them, even when the information may lead to the patient making the choice which is against their best interest. This information shows transparency and gives equality to the patients to level the playing field (Howe, 2008). A very apt question was raised by Kongsholm and Kappel (2017) regarding the consent being based on information or trust. The research conducted by them provided that in case of participants indulged in medical research, they do not rely upon the information provided to them to give their consent, but instead over the trust which they hold in the researching enterprise or the researcher. The Mental Health Act, 2001 puts an obligation on the healthcare professionals to inform the patients properly about the treatment they are getting, in order for them to gain full knowledge on their situation. This consent is required save for such situations where the opinion of the consultant psychiatrist feels that the treatment is required for the safety of the patient and for alleviating their condition, particularly when the patient is incapable of giving their consent. In essence, here the legislation also gives preference to paternalism over and above autonomy. The decision on the capability o f the patient to make decisions for themselves remains contested. This is because it raises questions on the patient being held capable of making the decision, as this is something which is subjective in nature (Donnelly, 2016). Gillick v West Norfolk Wisbeck Area Health Authority [1986] AC 112 presents a landmark decision where a number of complex legal issues regarding the consent of a minor person were raised. In this case, Mrs Gillick had sought and attained contraceptive advice from a local doctor while she was below the age of giving lawful consent to intercourse. This was based on the guidance which had been issued by the relevant Department of Health and Social Security. She sought a declaration from court asking for the guidance of department to be deemed as illegal and an inference with the paternal duties and rights. The House of Lords had to decide on the extent of parental control over their minor child and whether the child could give consent to medical treatment or contraceptive advice against the knowledge of wishes of their parents. The declaration was dismissed by the court. The consent for treatment could only be given when the person could be deemed as intelligent and sufficient enough t o understand what has been proposed (HRCR, 2018). Again, this highlights the subjectivity in making the decision on the person holding the right to given their consent and continues the clash between autonomy and paternalism. Though, it is a victory for advocates of adolescent autonomy (Cave, 2014). However, one should not forget that this was again based on the question of competence, of a person making decision for them, which is the theme of paternalism. Another substantial point in medical ethics is confidentiality. Confidentiality in healthcare field is of utmost importance as the patients share their personal information in a routine manner with the healthcare providers. In such cases where the confidentiality is not maintained, the data of the patients would not be protected and this would result in the trust present in the physician- patient relationship being diminished. This would make the patients less prone to sharing of the information, particularly the materially sensitive one, which would impact the care provided to the patients in a significant manner. Confidentiality is a necessity for creating a trusting environment where the patient privacy is not only respected but is also protected and encouraged, which allows the patients in being honest in their healthcare visits. This also has the capability of increasing the willingness of the patients for seeking care. In cases where the patients have a stigmatizing condition, which is related to psychiatric health concerns, public health, reproductive or sexual health, the confidentiality helps in assuring that the private information is not disclosed to any person, without their consent being given for the same (Fisher, 2013). This is aligned with the Data Protection Acts 1988 and 2003, where the privacy of individuals is to be protected (Department of Health, 2018). Confidentiality continues to be a key point which ensures that the patients trust the doctors. The moral basis of it is consequentialist owing to the fact that it is meant to improve the welfare of the patients. In essence, it is required for protecting the confidence of general public and for securing the public health. This ethical principle has been upheld for centuries through a Hippocratic Oath. The reason for the same is that in modern medicine, medical confidentiality is not absolute. And the same can be breached with consent, through law, and in public interest (Blightman, Griffiths and Danbury, 2014). Again, confidentiality not being absolute touches the discussion carried earlier in context of interplay of autonomy v paternalism and consent. Where there are concerns regarding the safety of another person, the medical information of a patient can be made available to a person who would normally not be provided with such information. In doing so, the good of the patient is gi ven supremacy, and the patient is safeguarded from credible threat of harm. Here a good enough reason has to be provided to show that the individual is in serious danger and the medical information is crucial. For instances, in cases of homicidal ideation, a psychotherapist or physician can be made to provide the details of an individual prone to harming others. Again, where there is a requirement by the law to provide the medical information in certain situations, the same has to be done (Bord, 2018). To bring the discussion to its conclusion, the preceding parts carried a discussion on the three most significant aspects which are crucial in the healthcare ethics. These three are consent, a clash between autonomy and paternalism, and confidentiality. The discussion started with discussion on what exactly informed consent is. Informed consent requires the patient to be provided with all the relevant information in order for them to make the choice of going forward with a medical procedure or treatment, or to avoid the same. The above carried discussion highlighted how there is a constant clash between autonomy and paternalism and different examples were given to show the supremacy of paternalism over autonomy. This debate is due to the difference in the two concepts where autonomy provides that the patients should be given the choice of making decisions for them, whilst paternalism shows that the experience and the knowledge of the doctors or the healthcare professionals is enough for them to make the wise choice even on behalf of the patient. Through the example of the pregnant lady, who had to lose her life as a result of autonomy being given preference, the supremacy of paternalism was supported. The last aspect discussed above was the due weight being given to the confidentiality of the patients in order for them to trust the healthcare professionals and for them to disclose everything without having to fear for the information being misused or wrongly distributed. However, even the confidentiality of patients is shown to be conditional. 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