whether autonomous decision necessarily reflects the wellbeing of a patient

 whether autonomous decision necessarily reflects the wellbeing of a patient

Aspects of patient care have frequently been encountered with ethical dilemmas, and physicians find themselves in a hard situation as they care for patients. The dilemmas can be resolved with a focus on maximizing benefits by respecting the decisions of the patient and minimizing suffering or harm to the patient. Patient autonomy is one of the ethical arguments that have been at the center of controversy for quite some time. Physicians are stuck in between making patient autonomy the ultimate ethical good in medicine and protecting patients from making their own decision that could be irrational. Patient autonomy is the state where the patient is in a position to control their personal choice without the influence of their health care provider. The concept makes room for patient education but does not allow the physician to make decisions for the patient. Therefore, this paper will focus on the ultimate positive direction to take and decide whether autonomous decision necessarily reflects the wellbeing of a patient.

Patient autonomy and the influence of decisions by doctors can be a hard line to navigate. It was until recently that patients were given the ability to make their own decision. In the past, this was not the case. Doctors made all the decisions for the patient. They would do everything from planning the care, prescribing the treatment, and the patient had no option but to obey. The current era of care has significantly changed where patients are involved in the course of their treatment to help them understand options in nursing and work in collaboration with the physicians to attain the goals of wellness. In ethical theory, significant development has emerged in recent years, where autonomy is also considered to be a basis for the requirement of respect (Kassim, Alias & Muhammed, 2014). In other words, a physician has the mandate of respecting the medical choice of the patient because they understand their bodies in a better way, the tolerance for treatment, and the style they would likely desire to receive care.

It is not easy for physicians to understand the extent to which autonomy is functional. They, otherwise, ask whether autonomy is used in all the situations in medicine. In cases where a patient is in a position to direct their action, then autonomous exists, but when they are not, autonomous does not exist (Kassim, Alias & Muhammed, 2014). This does not give room for patients to be in a position to self-govern. Instead, physicians are supposed to answer questions whether it is a good idea that patients govern themselves or the extent to which they are supposed to be allowed to do so. Opposing problems come into play. For instance, physicians have presented various concerns of what authority the patient has in self-governing; is autonomy necessary to a child, or is the child patient too uninformed and unreasonable to self-govern? Is a patient’s autonomous state a simple matter or instead of one is either independent or not, or is it context-specific, in that a patient can be more or less autonomous? Such issues have dominated ethical debates on the interaction period between the patient and the doctor, which has contributed to the rising of more issues (Kassim, Alias & Muhammed, 2014). For instance, doctors are not in a position to establish the kind and extent of information they are supposed to share with the patient concerning a proposed intervention. Likewise, patients do not know whether they are supposed to remain ignorant about details of their medical conditions and whether they are supposed to demand some intervention, even in cases where the doctor sees it as a harmful one to them.

Such insights have resulted in the emergence of terminologies like “temporizing,” which is waiting to pose a treatment question to a patient considered to have the capacity to make a decision. This is ultimately within the power of the physician who has the mandate to decide the period when he or she is supposed to present the matters that should in due course be for the patient to determine (Martinez et al. 2015). In most cases, it is difficult for the patient to be granted the full right to self-determination because they are not in full capacity to understand medical issues that are affecting their body. It is the collaboration between physicians and other healthcare professionals through decision-making procedures that anticipate the choices of the patients, which might be denied in case it does promote their wellbeing (Kassim, Alias & Muhammed, 2014). The concept rarely involves invasive and high-risk procedures but might concern minor routine issues. For instance, a doctor might postpone a discussion with the patient regarding the introduction of a new drug for a condition affecting the patient.

Furthermore, postponing discussions concerning the option of not trying to resuscitate the patient when heart arrest occurs or waiting several weeks to suggest to a psychiatric patient the treatment option that the physician thinks might be of help. Such minor routine issues might result in a conflict between the patient and the doctor. Here, the autonomy of the patient comes to play, but the physician might feel the choice of the patient is not the right one to make and might choose to ignore it.

Conflicts are much witnessed in life-supporting medical treatment in patients with chronic illnesses, primarily in the setting of dialysis experienced when caring for patients with chronic kidney disease (Carlin, 2013). The decisions made by the physician, in this case, have high-stakes medical decisions where the autonomy of the patient might be violated. However, the treatment might be harsh to the body of the patient, but the physician might not be in a position to tell; hence, prompting the patient to choose another treatment option or abandon the treatment altogether (Carlin, 2013). In this case, the physician might “temporize” his or her decision to determine or agree that the patient is in a position to be autonomous. If not, then the physician will not have any other option than proceeding with the choice they have on the table. These sentiments questions whether patient autonomy is actually necessary or the patient must sometimes be protected from making decisions.

The release of Beauchamp and Childress’s The Principles of Biomedical Ethics in 1977 to its current 7th edition has resulted in full acceptance of autonomy in conjunction with the principles of beneficence, non-maleficence, and justice (Beauchamp & Childress, 2010). In medical literature, scholars utilize the concept of autonomy in which patients are the ultimate decision-makers. Nevertheless, critics have gone against this prevailing view of patients using diverse viewpoints. They make use of paternalism, which stands in the opposite direction of autonomy. Paternalism’s objective is for the good of the patient the same as autonomy. It has been one of the characteristic features of therapeutic affiliation in medicine (Terlazzo, 2015). It suggests that the doctor is the one with the mandate of making decisions in the best interests of the patient, even for those patients who can make the decisions. It goes against an irrational patient who wants something that they feel has value for them but cannot explain how what they are contemplating of doing could be relevant to them (Terlazzo, 2015). However, this representation of the relationship between the physician and the patient that gives the physician the entire mandate to make decisions has harshly been criticized, especially in democratic countries.

Overall, patient autonomy is plausible when the patient is in the best position to determine what would be best for them, and there is good reason to consider their independence. As seen earlier, patient autonomy is self-rule that is free from both controlling interferences by the physician and from limitation to understand what is being diagnosed to prevent them from having meaningful choices. This means that the patient can select the desired plan of treatment. In cases where the patient’s decision is considered to have severe harm to their wellbeing, their autonomy should be restricted (Walker, 2009). Therefore, the physicians need to explain to the autonomous patient the consequences of their medical choices before administering the final uptake. They should make them understand the harm or loss of wellbeing they are to suffer in case they make bad choices.

It is ultimately essential for physicians to explain to patients what is good or bad to the patient rather than the value of patient autonomy. Provided that medical ethics talks about the bureaucratic idea of autonomy and more reasonable opinions for the view that patients’ autonomy has inherent importance, patients’ autonomy should be considered to have solitary instrumental value in medicine. Nevertheless, if rationality is indicated, autonomy should be excluded because a patient can make decisions that might cause harm to them and end up blaming the physician for the mistakes (Walker, 2009). Therefore, physicians can apply the temporizing techniques to allocate enough time that will help them determine whether they are in a better position to make their own decisions. Generally, patient autonomy is an ultimate ethical good in medicine, but physicians should practice temporizing to protect them from making their personal decision that could be irrational.