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.
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
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.
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.
This decision also has to be evaluated on the basis of internal criteria. For the internal criteria, a person has to look inside oneself to evaluate the decision. Does the person feel satisfied with the decision and promote these values? The doctor’s decision does not give the inner sense of contentment; we experience “hate, discontent…confusion” (Panicola 71). Nobody wants to become a liar, thus it is not consistent with the kind of a person one would want to become.
I was interviewed last June by Eric Zorn, a columnist from the Chicago Tribune. Mr. Zorn's "thesis," as he explained it to me, was this: if any partial birth abortions were being performed for truly "elective" reasons, for reasons the public would consider nonserious, as the pro-life movement was claiming, the movement should produce the mothers involved. I explained at some length that it wasn't "the movement" claiming that the majority of these procedures were "elective", this fact was asserted by the partial-birth abortion providers themselves. I sent Zorn Dr. Haskell's statements as quoted in the American Medical News. I also sent the charts Dr. McMahon had provided to the Subcommittee on the Constitution in which he had detailed the rationales for abortions he had performed. These documents showed the elective nature of the majority of these procedures -- and in the words of the abortionists themselves. I asked Zorn to reconsider his own logic: aren't patient records confidential and in the possession of the abortion providers themselves, I asked? And if you were a woman who had your healthy child aborted would you be eager to go public? Nothing, however, could shake Mr. Zorn's tenacious grip on his thesis. He ended up writing- "That explanation won't do. If these once callous, cruel, selfish women who drive this national debate truly exist, let's hear from ." (June 6, 1996). In a follow-up column, he wrote: "Well, there are late-term abortions, there are "partial-birth" abortions and there are abortions performed for non-medical or elective reasons. We find very little overlap ... because later-term abortions are very rare and almost always performed for serious medical reasons. . .." (June 13, 1996).
Each day throughout our world, medical professionals suction thousands of babies from their mothers’ wombs through a procedure called abortion. The law protects and provides consent to both the mother and the medical professionals for these procedures. However, the babies seemingly have no right to protection or life themselves because of the argument regarding when a fetus is determined be human and have life. Pro-life author, Sarah Terzo, in a LifeSiteNews.com article, relays the following testimony supporting this from a medical student upon witnessing his first abortion, “Rejected by their mothers and regarded as medical waste by their killers, society allows these babies to die silently, with no recognition or acknowledgment of their humanity” (Terzo).
Today, an abortion is done by a professional in the field that has had the specialized training to carry out the procedure. Before abortion became legal and easily accessible to women, many women were using back-alley or self induced abortions to get rid of unwanted pregnancies. The result of these unsafe procedures can be very devastating for both the women and the baby. Back in the early to mid 1900’s, wealthy women requiring an abortion because of severe medical reasons were generally able to find a physician who could perform an abortion. However, the poor women had to turn towards illegal and unsafe abortions, which ended in countless deaths and mutilations. Between the years of the 1950s to 1960s, it has been estimated that there were around 200,000 to 1,200,000 illegal abortions performed each year in the United States. Up to about 5,000 of these abortions ended with the death of the women having the procedure done. Because of abortion now being legal and accessible to all women in the United States, the death rate from getting one is extremely low, about 0.6 per 100,000 abortion procedures. Having a safe, legal, and effective place and way to get an abortion has overall been safer for the women getting an
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
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.
Roger Higgs, in “On Telling Patients the Truth” supplies commonly used arguments for paternalistic deception. For the purposes of this paper, paternalism will be defined as, “interference with one’s autonomy or self determination for their own good.” The first argument for paternalistic deception is founded on the idea that medicine is a technical subject where there are very few guarantees (613). Thus, Higgs supplies the argument that not only is it impossible for a patient to understand the true breadth of their diagnosis and prognosis, but additionally that medical predictions are not medical truths. The second argument for paternalistic deception comes from the belief that patients do not actually want to know the truth about their condition, and could suffer from worse health outcomes if they are told the truth (614, 615).
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.
During the last decade, patient involvement in healthcare has been on the rise. Patients are expected to be involved in health care as health systems have developed influencing CQI (Sollecito & Johnson, 2013). Individuals started to question the power healthcare institutions had. Pomey, Hihat, Khalifa, and others (2015) say that patient engagement can be defined as involvement of patients, their families or representatives, in working actively with health professionals at various levels across the health care system to improve health. Patient involvement influences the health care system as a whole. When the patient becomes involved, it allows them to gain some level of control ultimately leading to better health outcomes and lower health
Shared decision making is a process by which patient and practitioner consider outcome probabilities and patient’s preferences and reach a health care decision based on mutual agreement. Though the majority of patients express a desire for more information, preferences for participation in health care decisions vary by individual and by illness. Research shows that active client participation results in numerous benefits, from increased satisfaction to decreased symptom burden. Many current health interventions promote patient-centered care, but literature on shared decision-making is just beginning. In this essay, the importance of shared decision making will be discussed, pointing out the benefits for both patient and clinician and underlying