Medical Decision Making: Patient Autonomy vs Physician Integrity
Patient autonomy is the right for patients to make their own personal medical decisions without these decisions being made by the patient’s physician. The professional duty of the physician is to educate the patient as best as practical considering the circumstances about the details of the illness and the diagnostic and therapeutic options which are available. The physician must explain the benefits to be expected in the procedures or treatments but also detail the risks that are also possible and to compare the options with regard to benefit vs. risks. Of course, there may be one option which cannot be left out and that is: to do nothing. The explanation must be in the form of true education, providing the patient the facts that are known and accepted and should not represent intentional physician bias to one direction or another.
Then, the patient decides and informs the physician. But does that end the decision-making process? If the patient makes, to the physician’s impartial knowledge the wrong decision, a decision that may be in the short or long term harmful to the patient, should the physician remain silent? Should the physician, having a professional duty to observe and maintain the trust that the patient must hold in the doctor for beneficence, speak out if the physician finds that the patient’s decision is wrong, inappropriate or harmful? If the physician had known from the outset that such a decision could possibly be to the patient’s detriment, should that option even have been mentioned in the first place? That option, noted above, which virtually all patients are aware and the physician might find as a wrong decision would be to do nothing. Should the physician accept that decision as was made by the patient?
Regarding any decision, should the doctor insist that the patient explain to the physician’s satisfaction, the patient’s basis for the decision? If the physician is dissatisfied with the explanation, then what? Or should the physician, in keeping with patient autonomy, accept and follow any decision made by the patient? Where does patient autonomy end and to maintain physician professional integrity degrees of physician guidance extending to decision rejection begin? That is the question I pose to my visitors. ..Maurice.