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Ethical dilemmas for the medical field
Ethical dilemmas in the medical field
Ethical dilemmas in the medical field
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Austin Eby
Medical Ethics
Andrew Erickson
March 19, 2015
Medical Paternalism
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
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While Goldman’s argument provides excellent moral reasoning from a patient’s standpoint of view, it fails to fully detail the reasoning of paternalism from a medical professional’s standpoint. I agree that patient autonomy should be a priority and respected by medical professionals, but there are many cases that patients are not always able to make autonomous decisions. Conflict occurs for medical professionals when a state of equipoise in effect. Usually there is a question of what is best for the patient and whether or not to respect a patient’s autonomy. Is the patient fully aware of their condition and the risks of procedures? Is the treatment worth the pain and suffering of the patient in the long run? I do not believe that patient autonomy is one hundred percent more important than the treatments that could or is known to cure or extend a patient …show more content…
Not all cases is patient autonomy the most important thing to respect and honor. There will always be situations where Medical paternalism is justified. Justifiable paternalism in a medical perspective is prolonging patients’ lives allowing them to exercise their autonomy. Failing to respect a patient’s treatment requests or denials is a violation of the autonomy at that point in time during their illness. While the previous statement is true, the medical professional is violating a patient’s future autonomy. For this reason, medical professionals have the right to act paternalistically, therefore medical paternalism is justified by means of future autonomy and obligations to promote patient
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
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.
After reading Should Doctors Tell the Truth by Joseph Collins, I started steer away from Collins views. I disagree with Collins thesis because it isn’t permissible to take control of anyone’s autonomy whether or not it’s in his or her best interest.
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.
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.
Within public health, the issue of paternalism has become a controversial topic. Questions about the ethics of public health are being asked. The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied context (Med J Aust. 1994). Clinically, patients are treated on a one on one basis, but public health’s obligation is toward the protection and promotion of an entire population’s health. So, based on this difference, the gaping questions targeting public health now becomes, under what conditions is it right to intervene and override an individuals’ autonomy?
Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed consent, the patient must be aware and should be able to give a voluntary consent for the treatment and testing without being coerced, even if coercion is very little. Being coerced into giving consent is not voluntary because others people’s opinions account for part of his decision. Prisoners and the poor population are two areas where coercion is found the most when giving consent. Terminally ill patients also give consent in hope of recovering from their illness. Although the possibilities are slim of having a successful recovery, they proceed with the research with the expectation of having a positive outcome. As stated by Raab, “informed consent process flows naturally from the ‘partnership’ between physician and patient” (Raab). Despite the fact that informed consent is supposed to educate the patients, it is now more of an avoidance of liability for physicians (Raab). Although the physician provides adequate information to his patient, how can he ensure that his patient properly ...
The legal term of consent reflects a person’s agreement to something; while informed consent means that a patient has full knowledge of the possible consequences of the proposed treatment and has the right to accept or decline (Queensland Health, 2011). Informed consent is provided and gained during a conversation between a client and the treating health professional and is critical to providing patient-centred care (Freegard, Isted & Russell, 2012). This essay will aim to discuss the use of advance care directives (ACD) in healthcare using several ethical principles and theories such as respect for autonomy, beneficence verses maleficence and paternalism. It will also compare the professional and ethical frameworks of nurses and paramedics on the issue of ACD’s and informed consent.
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.
The principle of autonomy states, that an individual’s decision must be respected in all cases, also an individual can act freely in accordance to their plan. For example, in a case where a patient and family demands to continue medical or surgical care and a physician want the patient to stop further treatment. In this case the patient’s choice will matter the most. According to the principle of autonomy it will be the patients and family choice whether to continue or discontinue treatment. The principle of beneficence which states, “one must promote good” comes into play in this case. In accordance to beneficence the patient will not benefit from the physicians responses personally. He/she will not benefit from harming her body with more surgeries. The patient will be going against the principle non-maleficence, which states that “one must cause no harm to an individual” by causing harm to herself. In this case the physician is justified in his/her actions by discontinuing medical or surgical care to the patient because it will not it her. These principles are what healthcare provider use to help and guide patients with the ...
Steinbock, Bonnie, Alex J. London, and John D. Arras. "’Rights- Based’ Approaches." Ethical Issues in Modern Medicine. Contemporary Readings in Bioethics. 8th ed. New York: McGraw-Hill, 2013. 23. Print.
Physical therapy is a health care profession, which focuses on enhancing and restoring functional ability and quality of life to those with physical impairments or disabilities. This profession treats people with any kind of functional disabilities and improves their independence in activity of daily living through specially designed muscular skeletal exercises, massages and various types of modalities. One of the ethical dilemmas that has been presenting in not only physical therapy profession, but in other related professions as well, involves the interaction of patient and the therapists. In many instances, nurses, physical therapists or doctors know the conditions of the patients better than the patients themselves. Most of the physical therapists are trained to adhere the principles of beneficence. They are trained to believe that they must do what will benefit the patients' the health most and not harm them physically or psychologically. Sometimes patients may not want to receive or participate in the treatment session for various reasons. However, since most of the physical therapists know what needs to be done to improve patients' condition and desire their patient to recover as soon as possible, they may have to push, in some case, even force their patients to receive treatments.
The American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
The case of Dr. Lowell and Mrs. Jackson revolves around a conflict between the doctor, who advocates the implementation of a particular treatment and the patient who disagrees with the doctor and wishes to do things her own way. The doctor feels that the suggested course of action is disastrous and threatens to have the patient declared mentally incompetent. The question now is whether or not the doctor is morally justified in taking action against the patient in order to implement the course of treatment she feels would be most effective. Is this an infringement on the autonomy of the patient or is the doctor morally obliged to do everything that he/she can possible do in order to restore the patient’s health even if that includes to go so far as to take this decision out of the hands of the patient?