Patient Autonomy
Patient autonomy refers to a patient's freedom to make decisions about their medical care without being influenced by their healthcare practitioner. This idea permits health care practitioners to educate patients but not make medical decisions for them (WebMD). Autonomy is a core principle in clinical ethics. However, in medicine, autonomy does not only mean enabling patients to make their own decisions, but also creating the essential conditions for patients to make informed judgments. Confidentiality, obtaining consent for medical treatment and procedures, revealing information about their medical status, and respecting privacy are all examples of respect for autonomy. Others include presenting all treatment options to a patient, explaining risks in terms that a patient understands before agreeing to procedures or before going to surgery (Steven Pantilat).
Case Study
The case in reference presents a clinical dilemma in which balance need to be attained between patient's autonomy, family wishes and the physician's role of beneficence. The role of the physician here is to ensure they do no harm and this could be achieved by giving the patient the medical care that suits them (whether medications, reassurance or procedure), which clearly the physician has done. It is also the physician's duty to offer advice on better management alternatives for the patient. This has been observed in Dr. Radburn's efforts to wean the patient from the respirator to help him breathe on his own. Though the weaning efforts appeared unsuccessful, an assessment later with the patient under the use of the respirator indicated that he was fully competent. However, it is rather unfortunate that the patient got tired of putting an extra effort and appears to be giving up on life. In as much as the family and physician's efforts to save the patient are justified, patient's autonomy too cannot be overruled. On the other hand, euthanasia is a crime in clinical ethics and this intensifies the dilemma.
Physician's Decision
It would not be wise for the physician to honor the patient's wish. Assuming the patient was legally competent to make medical decisions, physician's refusal or postponing the idea to stop life support would be justified on the basis that the physician is expected to respect medical ethics and also uphold their beneficence responsibility (to do no harm). If there is much the physician can do, it is to educate the patients on the benefits of the life support, the ethical considerations that need to be respected while at the same time acknowledging the rights of the patient. The physician ought to establish a tough love relationship with the patient while also bringing in the moral support of the family. The family's wish to save the patient is ethically right, it is in good faith, and therefore bears much weight.
Alternative Decisions
Clearly, a number of alternatives to making the final decision exist. First, based on the patient's right to make his or her own medical decisions, the physician could decide to stop the life support as per the patient's wish. This would mean the patient risks death and the physician faces a legal suit for not upholding ethics. Secondly, the physician guided by clinical ethics and family wishes, could decide not to cut off the life support and instead compel the patient to continue using the respirator. The third alternative would be a combination of psychological, moral and medical support. This would mean counseling the patient and reassuring him with an intention of alleviating anxiety and fear to breathe on their own; that is restore the confidence in their respiratory system. Moral support would entail educating the patient on what is right as per clinical ethics, conditions for their autonomy and what is good for their family. Medical support would mean continued use of the respirator alongside attempts to wean the patient. This third alternative would cater for the feelings of all; the patient, family and the physician.
Decision Based on Kantian Ethics Approach
Based on Kantian ethics, I would pick the third alternative as the best decision to make to address the case in question. As is brought out in this approach, each human being has inherent worth and human reason facilitates human autonomy. Kant's idea champions for decision rule for right action; that one should act on motives they would want to be universal law (Pojman and Fieser). Unlike the utilitarianism approach that allows one to use whatever means or act on whatever motives just to achieve an end that increases happiness, the Kant way points out that you should not do what you would not want others to do. As a physician, and a human being too, no one would want to be denied of their rights to make medical decisions. Again, everyone is entitled to all the support that would be available to alleviate his or her illness. It is also okay to be weighed down by emotions just like the patient in this case. Again, the physician must fulfill their responsibility of providing a well-rounded treatment approach. Therefore, to ensure the rights and concerns of every party involved are considered, then the third alternative would be the best way to go.
Critically, the first alternative would still be a good decision justifiable by utilitarian approach. This alternative would see the patient's desire to get relieved of the torture of several procedures on top of his illness, fulfilled. On the same note, the family's resources would be preserved. From a physician's perspective, they would be happy to have honored their patient's wishes. So to some extent, some degree of contentment would be achieved. The second alternative would see the patient continue with the respirator without any other choice. A strained relationship would ensue between the patient and physician. The patient would lose trust in the physician, feel intimidated and belittled, feel denial of his autonomy, but then the physician would be glad for being able to have the life of the patient stable. Therefore, either way, there would be a party to gain and that to lose creating an imbalanced situation. Moreover, this leaves the third alternative.
Conclusion
To keep everyone at par, a stand where each party benefits, despite of the hard choices that each party has to make should be adapted. The third alternative provides this all; the physician may seem tough on the patient but they will be in a good position ethically. The patient will have to persevere more and perhaps feel as if they have to put up with the physician and family demands, but they can then be assured of improvement in their health. The family may experience a drain of resources while supporting medical care, but then this would never be compared to the joy to see their loved one get well. Either way, a decision has to be made; given another chance I would still go for the third alternative.
References
Pojman, Louis P. and James Fieser. Cengage Advantage Ethics: Discovering Right and Wrong. Boston: Cengage Learning, 2016. Online.
Rachels, Stuart and James Rachels. Right Thing to Do: Basic Readings in Moral Philosophy. New York: McGraw Hill Higher Education, 2015.
Steven Pantilat, MD. Autonomy Vs Beneficence. 2008. 16 March 2017. .
WebMD. Medical definition of patient autonomy. 25 1 2017. 16 March 2017. .
