Bioethics Discussion Blog: Physician Autonomy vs Beneficence to the Patient and Plan B

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Friday, January 28, 2005

Physician Autonomy vs Beneficence to the Patient and Plan B

When Dr Ward comes into the exam room Theresa explains to him that she was out at a party, had a few too many drinks, and ended up having unprotected sex with her boyfriend. She says she is worried about the possibility of being pregnant and wants the Plan B® pill.
“I don’t want to have a baby right now. I’m too young. I have to finish school,” she says. “And I don’t want to have to make a decision about an abortion. I want to just take this pill and move on.”
Dr Ward listens to Theresa’s concerns and then says, “I understand why you are here. I have always had a policy of not performing abortions, and I won't start now by prescribing the morning-after pill. You can make an appointment with me in a couple of weeks for a pregnancy test to find out if you are pregnant. If you really want the morning-after pill I can give you the card of a physician I know in Gardendale who will see you.”
“Gardendale?” Theresa says. “But Gardendale is 115 miles away. How will I get there without telling my parents why I am going? And how will I get there soon enough for the pill to work?”


I have written recently about Plan B and the anticipated decision by the FDA to allow over-the-counter (OTC) patient access (see postings of Jan 18 and Jan 23, 2005). The above scenario with two commentaries following, in the September 2004 issue of Virtual Mentor illuminates an important ethical issue that could be resolved by approval of OTC use. The issue involves the right of a physician not to engage in a treatment, which to the physician is morally wrong. This autonomous right of the physician has generally accepted ethical consensus. However, in certain situations, acting on this right may be non-beneficent for the patient by leading to the patient experiencing personally serious consequences. This conflict between the principle of professional autonomy and the professional duty to patient beneficence, in the case of Plan B could be mitigated by the FDA approval of the OTC procurement of this drug. ..Maurice.

4 Comments:

At Wednesday, February 02, 2005 11:49:00 AM, Blogger jb said...

What's the issue here? Surely no one would object if the other doc was across the hall rather than in Gardendale, opening a new practice and therefore able to see Theresa right away, and a founding member of NARAL. The issue seems to be that Dr. Ward is expected to violate a deeply held ethical belief because it is inconvenient to Theresa for him to keep this belief. I disagree. I'm sympathetic to Theresa, and I would have no problem writing the Rx for her, but I will defend Dr. Ward's absolute right to decline to write the Rx. I agree that Plan B, and just about every other Rx med, should be OTC, but that is an entirely different discussion.

If you want a truly interesting discussion, postulate that Theresa is hemorrhaging, in shock, and Dr. Ward is a Jehovah's Witness...

 
At Thursday, February 03, 2005 1:54:00 PM, Blogger Maurice Bernstein, M.D. said...

If Theresa was not a JW and would accept blood transfusion, there might be no moral reason why the JW physician should refuse to transfuse due to his/her own personal religious reasons. I don't recall there is any religious penalty in JW for administering blood to a non-JW but only for personally accepting blood. Participating in administration of blood by a JW is not analogous to morally refusing to perform an abortion or to participate in physician assisted suicide where in contrast to administering blood to others which is an act that can be morally acceptable those other acts might not be. . ..Maurice.

 
At Thursday, October 27, 2005 12:21:00 PM, Anonymous Anonymous said...

Argue for or against this claim: A competent patient has an absolute right to refuse medical treatment. (Or: Under what conditions, if any, should a competent patient's refusal of treatment be overridden?)

What are the ethical principles for and against autonomy?

Please reply to chrisawol@hotmail.com

I am a pol sci / Phil student at the university of Michigan and have to write a paper with a professionals opinion on this subject. In an interview format, since I do not know any MD's I was hoping we could have some dialogue.

 
At Thursday, October 27, 2005 8:45:00 PM, Blogger Maurice Bernstein, M.D. said...

Competency of a person is really a legal,court decision. On such a designation of being competent, any person can refuse even life-saving medical treatment. If a patient is shown by clinical examination that the patient has a significant depression, then the capacity of the patient to make their own specific medical decision might be said by the patient's physician to be lacking. A patient lacking capacity to make their medical decisions, must have a surrogate make decision on substituted judgment or best interest. ..Maurice.

 

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