Consent and refusal

The mutual duties of patient and professional are unquestionably essential towards creating a trustful relationship. And considering what is laid on the line- the patient’s well-being- significant attention must be given to this aspect. What does the term “autonomy” mean? To what extent can a doctor influence his patient’s decisions? What are the difficulties being faced in this area?

And, more importantly, what can we do to improve the current situation? Autonomous choices are defined by as having three qualities Ganzini et al (2004).

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One such quality is that the decision is based on reasoning and rational analysis. In a related article, Gawande (2003) narrates how, in some cases, physicians are better at this, since they are less emotionally attached to the situation. He shares an experience where he himself gave that duty to other doctors when his daughter was the patient. Occasionally, patients, or their relatives, whose decisions may be influenced by emotional attachment (the want to relieve the patient immediately of pain perhaps), prefer to have others make their medical decisions.

He refers to Schneider’s (1998) study to verify this, and implies that in such cases, the decision not to decide is still a practice of the patient’s autonomy. Another quality is that the patient must be adequately informed about his condition and the options that may be taken, and it is in this area that I find much shortcomings both in the patient’s and the doctor’s part. An excuse that some professionals might make for not disclosing information is that the difference in intellectual acquirements between themselves and the patient may lead to the latter’s incapability of wholly understanding.

Some might also fear the possibility of being misinterpreted. However, such reasons are not sufficient, as this task of communicating accurate, though not necessarily complete, information is part of the professional’s obligation. This may involve more than the mere delivery of facts, but consideration of the possible interpretations and effective presentation of options as well Yeo (1991). On this note, the question of to what extent may a doctor influence his patient’s decision is raised, and this question touches the third quality of autonomous choices, which is that they must be voluntarily made.

Gawande says that “. . . There was also the new and delicate matter of talking patients through their decisions (emphasis mine),” the last phrase connoting giving suggestions that he prefers to term “doctorly manipulations”. Though this might sound controversial, he emphasizes how sometimes, doctors choose to shove patients towards making decisions which will be right for them. He gives examples of such situations from his experience, and depicts how, had the patient not been swayed by the doctor, the patient’s condition could have worsened.

I do agree with him when he says that neither doctor nor patient makes all decisions and that both parties’ ideas must be heard. Nevertheless, I believe that whatever suggestions made by professionals remain as suggestions- suggestions definitely worth listening to. In the end, a doctor can only try to persuade his client so much. Gawande might term this as ethicists’ wrong promotion of patient autonomy as an ultimate value. But I think that in such cases, this arrangement of open exchange of ideas is the best compromise for both parties.

Improving the current state of patient-professional relationships involves taking several steps, and the most significant one I perceive is emphasizing to patients and doctors the importance of their roles in medical procedures. It is helpful that issues such as these are being brought up in academic discussions. Hopefully, all institutions aiming towards this improvement are highlighting how making the extra effort of having that 5-minute decision-making dialogue is very much worth it. BIBLIOGRAPHY

Ganzini, L. , Volicer, L. , Nelson, W. A. , Fox, E. , & Derse, A. R. (2004). Ten myths about decision-making capacity. Journal of the American Medical Directors Association, 5, 263-267. Gawande, A. (2003). Whose body is it anyway? In Complications: A Surgeon’s Notes on an Imperfect Science (pp. 216-227). New York: Picador. Schneider, C. (1998). The Practice of Autonomy. New York: Oxford University Press. Yeo, M. (1991). Concepts and cases in nursing ethics (pp. 92-95). New York: Broadview Press.