The Role of Patient Autonomy - Essay Example

Running head: PATIENT AUTONOMY Patient Autonomy Autonomy has great importance in patient treatment. Although doctors and physicians have knowledge about diseases and their treatments, Patient know much about his own body and there are many factors in which patient's decision about way of treatment is important. This paper deals with these issues and discusses about solutions. Patient Autonomy Introduction What is autonomy It is self government or self determination. It entails forming a plan for how one's life is to go through time, choosing course according to what one judges is best for oneself. It is not mere desiring but evaluation and weighing of alternatives by a person and selection based on her priorities. There are many ways we can discuss patient's autonomy. Medical confidentiality Discussion on medical confidentially usually focus on tension between physician's responsibility to keep patients secret and a physician 's legal and moral duty, on occasion, to reveal such confidences to their parties, such as families, employer, public health authorities, or police authorities. Confidentially serves as dual purpose. Firstly, it acknowledges respect of patient's privacy. Patient's most personal physical and psychological secrets are kept confidential to decrease sense of shame and vulnerability. Secondly, it is important in improving healthcare. Promise of confidentially permits people to trust and thus patient are encouraged to communicate honestly and forth rightly with their doctors, which is most important for their treatment. According to Siegler (597) challenges to confidentially arise because of patient's personal interest in maintaing confidentially come into conflict with his personal interest in receiving best health care. Modern high technology health care is available principally in hospitals which require many trained and socialized workers. And thus in order to provide best health care patient's medical records need to reveal to these workers. Again these treatments are very costly and can be afforded by few patients only. So it becomes essential to grant access to patients medical records to persons who are responsible for obtaining third party payment like chart viewers, financial officers, insurances advisor and quality care assessors. Siegler suggests some possible solutions to confidentiality. Those are: 1. In all nonbureaucratic, noninstitutional counters care should be taken to guaranty safety and confidentiality of patient's records. 2. Access to patient's records should be provided to only "need to know" persons. At some point most of patients should be given opportunity to review their medical records and make choices about which records to make available to everyone. This can be done by dividing entire records in different sections like medical and financial section. So only health professionals have access to medical information. But again keeping all records different leads to complexity in analyzing patient's problems. Thus Author want to tell that principle of medical confidentiality described in medical codes of ethics no longer exists. And by devoting attention to determine aspects of confidentiality worth retaining, public and profession can be better served. Truth- telling Should patients know the truth Is a very difficulty question that confront physician. According to Collins (605) telling the whole truth is often to perpetrate a cruelty of which many are incapable. This is particularly true of physician and if not they soon learns that art of medicine consist largely in skillfully mixing falsehood, and truth in order to provide patient with an amalgam which will make the metal of life wear and keep men from being poor shrunken things, full of melancholy and indisposition, unpleasing to themselves and to those who love them. Based on experiences Collins (609) conclude that the patients do not want to know the truth about their maladies and that it is prejudicial to their well being to know it. No one can stand the whole truth about himself. And even though he could, who knows the truth Dieses may have fatal ending, but one does not know that tomorrow it may no longer true. Physicians have opinions based on their own and other's experience they should express their opinions to sick person, event then it should be opinion, not a sentence. Doctors should be detectives and counselors, not juries and judges. Liberty Liberty deals with dealing of society with the individual in the way of compulsion and control. Usually The means use are physical force in form of legal penalties or the moral concern of public opinions. According to Mills (621), the only purpose for which power can be rightfully exercised over civilized community member, against his will, is to prevent harm to others and for his own good. Reason for this compulsion is it will make him happier, because, in the opinions of others, to do so would be wise, or even right. Mankind are greater gainers by suffering each other to live as seems good to them, than by compelling each to live as seems good to the rest. Mills argues that each is the proper guardian of his own health, whether bodily, or mentally and spiritual. Author concludes, based on experiences, No society in which these liberties are not on the whole, respected, is free, Whatever may be its form of government and none is completely free in which they do not exist absolute and unqualified. Mills argues that the only freedom which deserves the name, that of pursuing our own good in our way, so long as we do not attempt to deprive others of their, or impede their efforts to obtain it. Abandoning informed consent Consent, may be what can called a transition concept, one that appears on the scene as an apparently progressive innovation, but after a period of experience turns out to be only useful as a transition to a more thoroughly reversionary conceptual framework. Usually physician does not have to go through the process of getting consent; by and large consent is taken as given. Actual consent is not obtained in all cases, and even when consent is obtained, it may not be adequately informed or autonomous (Vcatch, 636) Thus it can be said that consent is no longer adequate as a mechanism for assuring that the patient beliefs and values will help shape decisions about what a patient ought to do. An alternative suggested by Vcath (643) is Patient may be presented a list of possible treatment options, together with summary of potential benefits and risks of each. It is important to emphasize that choice is conceptually different from consent and potentially replace consent as basis for patient involvement in health care decisions. But still there are some Problems to this solution. Those are 1. Physician can not present possible solutions unless he or she has knowledge of patience's belief and values. 2. Some options may be so offense to some parishioners that they ought not to present them. 3. The choice alternative may go part of the way toward giving the patient more active control. So it is nave to believe that it will solve problem with consent mode. Thus patients should be allowed to choice between possible treatment options after proper survey of patient's believes and possible treatment results. Life-sustaining treatment. According to Savulesca (646), No one throws life, when it is worth keeping. Quality of life, living wills, advance directives, respect for anatomy, right to die are very important factors and no one should be compelled to live life which has become a burden. This relates to life sustaing treatment that it ought to be limited if patient wishes so, which shows patient's autonomy, in other words it promotes patient's best interest. Some expressed desires actually prevent a person achieving what she judges to be best for her. These relate to family and society and can be named as treatment limitations. So we have to look more carefully at a person's desire to die before satisfying to show respect for her autonomy. Based experience, In relation to limitation of treatment of incompetent patient who were previously competent Savulesca concludes: 1. If past desires of patient are to be considered, they must have been formed by a person who was in possession of all relevant, available information, without any logical errors. 2. It ought not to be presumed that past competent desires and advance directives were autonomous. 3. It is not enough to know what incompetent patient would now desire if he were competent, but would rationally desire. 4. Treatment of incompetent person ought to be limited if limitation is what she did rationally desire. Amputees by choice Healthy people seeking amputation are not rare as one might think. There are thousands of cases where physically fit person want to cut off their limb. These are psychopath. But still autonomy comes into picture. Whether these people be allowed to do what they want Based on case studied Elliott (625) says that there is no treatment for these types of persons. After refusal to so also they will try to do what they wish to do, by any means. Thus one side of treatment is to satisfy their need which patient autonomy. Refers to but other side is what right according to social ethics and policies. Conclusion Every person have right to decide how his life should be and society should respect one's autonomy. But some times this autonomy comes into conflicts with responsibility toward family and society. There are many factors which need discussion about prioritizing one's autonomy. So after some studies we can say that own wishes are always important, still need to value social ethics. Read More