Up@dawn 2.0

Tuesday, May 3, 2016

Who Really Knows Best? (Report #2)

            Within the patient-physician relationship, there is an underlying, mutual understanding between the two parties in which there is a sense of responsibility and obligation among them. To clarify, a health-care provide is obligated to provide the recipient of treatment a fair and unbiased opinion towards the patient's diagnosis, prognosis, and overall condition; in other words, the medical professional should be able to provide the patient with all the necessary information he/she may need prior to treatment in order to make a well-informed decision on whether or not they may want to undergo a particular type of therapy/regime. In the same manner, the patient is more or less obligated to listen to what the physician may need to discuss with them in order to fully grasp and understand how a certain procedure may affect them. The question, then, lies at which of these two groups really has the optimal/"best" say in regards to the situation at hand. Is it solely dependent on the client? provider? Or, is it a type of situation that demands a compromise between the two?

                In regards to the decision-making process involved in this issue, autonomy is a major bioethical concept that revolves around this particular topic. In the clinical setting, autonomy is defined as granting the patient with the ability to make a self-mandated decision without any external influence or coercion. The medical-provider's role in this case would be to provide the patient with all of the necessary, unbiased information in order to enable the patient to make an autonomous decision. Now, this goes without saying that confidentiality, respect for the recipient's well-being, and their right to deny or accept treatment is accounted for. For means of a practical application to this concept, take a patient who is plagued with some sort of dementia and place yourself in their shoes. Now, imagine losing the ability to properly function on an everyday basis as a result of gradually losing the ability to make simple snap decisions or remembering simple things (I.E: Brushing Teeth). Would you want the doctor to provide you with a treatment that may prolong suffering or reduce suffering based on a paternalistic approach, or would you prefer to have the ability to decline or accept that treatment based on a self-rule approach? Given that scenario, this case would best be resolved via providing the patient with the necessary information in order for them to make a well-informed, competent decision with respect to the physician's best intent for treatment.

                On the other side of this issue, beneficence is a concept that surrounds the idea of the physician's moral obligation not only to his/her respective patient but also the society as a whole. Clinically speaking, beneficence is defined as the act of ensuring that the well-being of the patient is secured and that the chance of harm is minimized among the patient and/or society. The medical-provider's role in this case would be finding a way to treat the ailments of his/her patient while ensuring that no future harm may be brought upon the society or upon the patient himself/herself. This does not simply imply that the doctor may ignore the autonomy of the patient, but it means that the physician must provide a means of treatment that is non-maleficent. In other words, the treatment must only be considered in the case that the benefits outweigh the negatives. In example, consider a situation in which an individual with early symptoms of tuberculosis is examined by a health-care provide and refuses to undergo treatment due to reasons that the individual deems as reasonable (I.E: Religious, Personal, Health etc...). Would the doctor be validated in breaking the autonomy of the patient in order to treat the individual as a means of securing the health and well-being of the patient and the society as a whole? In this case, the medical professional should continue to explain the possible outcomes of treatment/lack-of treatment to the individual with respect to their autonomy. Likewise, the patient should listen and ponder upon the 
suggestion(s) of the physician with respect to their professional role in order to make a well-informed decision.

                All in all, I think that the patient-physician relationship is one in which a mutual sense of respect and understanding is required in order for proper functionality. The two parties must both equally have an unbiased respect for each other's autonomy and knowledge base. Of course, there will be outliers to this group in which some individuals (doctors and patients) may refuse to adhere to the aforementioned bioethical concepts as it is not always easy to find a balance between them; but, the basis for whoever has the "best"/optimal say in the procedure or treatment is formed when these concepts are followed. In conclusion, after reflecting on the texts we've read this semester, I think the most important thing for health-care providers and caregivers to know or do is provide an unbiased and well-intended opinion for any recipients who may seek their assistance.

Here is a video about a physician on his view of the old vs. new doctor-patient relationship:


1 comment:

  1. Funny, how cultural attitudes on this subject have shifted. I remember popular TV shows from my youth featuring and extolling highly-paternalistic physicians, Dr. Kildare, Ben Casey, et al... the mirror-images of "Father Knows Best". (But that was also an era that gave us "My Mother the Car," "Mr. Ed," and other preposterous scenarios.) Now we have "Reality TV." Hard to say which was better (i.e., least-awful).