Abdominal Aortic Aneurysm Case Study

As defined by Baillie, Garrett, Garrett, and McGeehan, the health care formulation of the principle of autonomy states that “you shall not treat a patient without the informed consent of the patient or his or her lawful surrogate, except in narrowly defined emergencies” (Health Care Ethics: Principles and Problems, 2009, p.32). An abdominal aortic aneurysm is a very high-risk diagnosis, but is non-emergent unless the aortic wall ruptures. It may seem that the patient is assuming very illogical and risky behavior, but it is still her right as a patient to deny the surgery if she so chooses. Unfortunately, the physician’s actions cannot be justified in this case because although the diagnosis was an acute one, it was not yet emergent. The surgeon

violated the woman’s autonomy, as it was her decision to live with the consequences of refusing the surgery. Although time was of the essence in this case, the patient consciously denied the surgery, so it is the physicians’ obligation to provide the proper disclosure to the patient regarding her decision. The best possible combination would have been a the substantial disclosure rule and the prudent person rule to most efficiently communicate the risks and consequences associated with the patient’s decision as well as describing this information in the patient’s point of view to allow her to make the most sound decision for herself.

The prudent person rule tells the physician to disclose the information necessary towards making a decision to accept or deny treatment. This includes describing her diagnoses, the nature and purpose of their proposed surgery, evaluating with the patient the risks and consequences associated with their decision to refuse surgery, proposing the benefits to be expected if the procedure goes successfully, and if applicable to this situation, a valid prognosis if the surgery is still refused as well as the possible long-term costs associated with refusing treatment. The development of a relationship with the patient, although time is of the essence, comes with applying the subjective substantial disclosure rule, which tells the physician to “describe to the patient everything that would be material or important to the particular patient and not merely to a fictional reasonable and prudent person who makes the decision” (Baillie, Garrett, Garrett, McGeehan, Health Care Ethics: Principles and Problems, 2009,

p.39). Like mentioned above, a patient’s autonomy must never be violated unless under emergent circumstances. A court order would not have made this an ethical action, as the patient was fully awake, alert, and competent. She made the decision to refuse surgery under non-emergent conditions, and even a court does not have the right to take away her autonomy under these conditions. To further back up this claim, the surgeon acted in a paternalistic manner, as he didn’t override the patient’s need for consent to prevent the patient from causing injury towards others or to prevent an act in attempt to commit suicide. Assuming I was one of the healthcare workers, I would assume the responsibility within the scope of my practice and apply the substantial disclosure rule and the prudent person rule towards communicating with the patient further and letting her know in the most professional manner possible that her life is valuable, and that her occupation will be of no use if she dies because her aneurysm bursts. In this case, leveling with the patient and communicating with them would most likely influence the patient more efficiently than merely listing consequences and risks of her decision to refuse surgery.