Ethical Analysis in Medical Indications - Coursework Example

Medical indications Medical indications can easily be seen as the most logical starting point of ethical analysis for any case. This particular termcomprises reviewing medical situations, clinical discussions, diagnosis as well as identifying treatment options. It is related to Beneficence and Non-malfeasance. Beneficence is what the health care provider aught to do as a function of seeking to help the patient in promoting health and preventing harm based on his/her skills and knowledge. Non-malfeasance concerns both the risks and the benefits in deciding the medical treatment with the obligation not to harm others. The treating physician has to maximize the benefits and decrease the harm for his/her patient .However, there are times when the physician, the patient and/or patient`s family might find it difficult to proceed; due to the fact that harm and benefit are not in a balance. In the case of J.R., the patient was complaining of leg pain for which he sought medical consultation. Further, the medical consultation resulted in a recommendation for a bone biopsy; a biopsy which showed bone cancer. The physician decided to start the treatment immediately. The treatment was chemotherapy with a chance of leg amputation. But it was not clear what was the probability of amputation. Considering the medical situation, a decision to disclose the information regarding the treatment plan with a chance of leg amputation will result in a psychological harm to the patient. The harm is that the patient knows the diagnosis before the graduation. Another harm would be expected when the patient gains an access to his lab results and knows the diagnosis by himself. This will prevent the patient from enjoying the graduation. The physician is facing a challenge to his duty in truth telling. Patient preference This quadrant is derived directly from the ethical principle of respect for patient autonomy. Furthermore, this deals with what the patient prefers if he is competent and his presumed wishes if he is not competent. J.R. is a competent adult. This is clear when the treating physician had obtained J.R permission to speak to his parents after the surgery.This suggest that the physician had assessed the capability of J.R and realized that the patient has the right for confidentiality and to choose whom to share the medical information with. What is the preference of this capable adult? This is unknown with regards to this particular case; however, it is related that the mother`s preference is to let her son fully enjoy the graduation which will not be possible if the diagnosis of bone cancer is disclosed. She wants to delay any psychological harm that might take place as a result of a premature revelation of disease. It is appreciated that the parents are considered the best to choose on behalf of their children based on the special bond they enjoy. But does this give them the right to violate their children`s autonomy and the principle of truth telling; this is the greater question. There is a conflict between the respect of autonomy and beneficence and non-malfeasance. By asking the physician to lie, the mother is asking him to disregard the principle of honesty to the patient. The physician has an obligation toward the patient to tell him the truth, promote wellbeing , integrity and respect his autonomy. It is morally unacceptable to lie. Truth telling is needed for preserving the doctor-patient relationship; as it depends on trust and integrity in medical practice. There is a chance that this trust can get lost. This can happen if the patient, while being deceived, attains access to his medical information. The delay in disclosure might not affect the medical outcome of the disease; however, it might shatter the trust between the patient and his physician and his parents for a long time. If this happens, the patient will be in severe psychological harm in the time where he has to deal with issues as the chance of leg amputation, possibility of death and future fertility which could be affected by chemotherapy. Moreover, the patient is starting his adulthood and this period is one of the most difficult times to receive a diagnosis of cancer, as he is preparing himself to gain independence from his parents; yet being diagnosed with cancer makes him dependent again on his parents for support. Lying in medical practice affects not only the patient and the doctor in losing his good reputation, but also affects the society where patient trust in health practitioners is the basis of the medical system. The physician needs the patient to understand and assist in their treatment plan. Thus, the patient is expected to show intelligence, individual decision-making, and courage; all of which will be affected when the patient discovers that he was deceived. This deception might impact further investment in the treatment. Quality of life Any disease or injury has the possibility of affecting the patient`s quality of life. The main goal of ,medical practice is to restore , maintain and improve quality of life. This quadrant deals with the effect of the quality of life on the ethical judgment , and this makes it is critical since it gives chance for bias and preconception. When evaluating the quality of life for J.R. before the diagnosis, he is a hockey player who has been offered a scholarship at several US colleges. He does well in school; especially in math and has a small group of friends. His mother is a physician and his father is a businessman who both relocated to Canada from South East Asia soon after they were married. His mother thinks that the best quality of life for her son, after the diagnosis, is to be ignorant of the diagnosis till the time of graduation; as long as his quality of life will be affected negatively by the knowledge of the diagnosis. She is actually making a (quality of life) decision on his behalf. One must consider what might happen in case the patient received the information from via the internet or some other source while being deceived by his physician and/or parents? What will be his quality of life then and after? He will lose the trust with his treating physician and his parents in the time when he needs honesty to receive quality answers to his questions. The subjectivity of the quality of life makes it an area that is significantly affected by the patient`s own preferences. While the patient`s preferences are not known in this case, still it is not accepted to receive the mother`s preference instead. The physician should be guided by the physician-patient relationship which is founded upon trust and dignity. Contextual Features In medical practice, the physician treats the patient; while at the same time considering several social factors which can positively or negatively influence patient care. These factors, which determine the context of a medical case, include the dynamics of the family, cultural and religious belief of the patient and the family, and the living situation of the patient. The final quadrant deals with these contextual features and the impact of the ethical decision on the patient and his family. When considering the contextual features in the case, the father gave his wife full responsibility in dealing with the issue of disclosure. He believes that being a physician gives her the chance to decide in a better way. Recommendations It is not accepted to lie to the patient since he is a capable adult. The physician should tell the patient the truth about his disease in the presence of those whom he chooses. Even if disclosure had harmful effects, deception and violating the truth telling principle could not rest on utilitarian grounds alone. Although many health practitioners rely on such consequentiality in withholding information, the truth should be honored and disclosed. Kant stressed on the relation between truth telling and the dignity of humanity in an individual. Right actions promote human dignity and respect for human beings. Wrong actions undermine dignity and the respect for humanity (Beauchamp 2009 ). The Council on Ethical and Judicial Affairs (E-8.08) states that the patient`s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. While the Canadian Medical Association Code of ethics (22) recommend to make every reasonable effort to communicate with your patients in such a way that information exchanged is understood. It is the responsibility of the health professional to judge how much information to give to the patient. Telling the truth can be upsetting; but the physician`s role is not to protect the patient from receiving information. Anticipating that another will be saddened or distressed with bad news should not be confused with the evidence that they do not wish to know of their diagnosis. Randle and Downie comment on this type of situation: The carer’s feeling in this regard is not morally relevant. This may seem a hard thing to say, but it needs to be said if the patient`s right to the truth is to be upheld. It is also important to help the mother in dealing with the situation since she is a mother and a physician. Yet, the fact that she has both roles might affect her evaluation of the ethical issues. The physician should help J.R. and his family to realize the bad news and help the patient to understand the medical situation included in the diagnosis, treatment, and the side effects of treatment. An open discussion is needed to be carried with the patient and his family. Read More