Informed Consent and Ethical Challenges
Informed Consent and Ethical Challenges
The major ethical consideration in this case is the idea that Mrs. G had a chance at recovery and, instead, is opting to allow her illness to take her. In this case, it is important for the medical practitioner to understand the obligations that they have towards the patient in regards to her right to make the decision for herself. In this case, while the treatment has a chance to help her, it also has very low odds of doing so. Furthermore, the costs that the family will be left with seem to outweigh the potential benefits of the operation. This demonstrates the need to critically approach the incident in relation to the underlying conception that the medical community has regarding the rights of patients and the ethical ramifications of specific decisions being made in pursuit of their care. This issue can be better understood in relation to the conception of patient autonomy in the modern world.
It seems that, historically, there was not much consideration given to the basic autonomy of the patient and their rights in making medical decision for themselves. According to Carrese, in the past “patients have been accorded insufficient weight in the process of medical decision making” (692). Often, the decisions of the doctor would supersede the wishes of the patient. Over the latter half of the twentieth century, however, there were profound changes in how this was viewed, and the patient's right to information and autonomy have been viewed in an increasingly higher regard over the past few decades. In modern medicine, patients are generally given the right to make informed decisions for themselves, “unless there is a threat of harm to a third party, an inadequately treated psychiatric illness, or a concern about capacity” (693). Any of these concerns might be grounds for the denial of the patient's autonomy in a given situation.
The idea of informed consent essentially represents “an ethical imperative to promote personal well-being and self-determination” (Kleinman 1219). In this sense, these factors should be taken into account in regards to the medical practitioner's decision as to whether to allow them to refuse treatment. In this case, the decision that Mrs. G made seems to be within her own domain of autonomy. Her condition did not seem to leave her in a state of inability and her mind seemed to be all there as well. For this reason, it seems that the medical practitioners would have no choice but to allow her to refuse the treatment. These laws seem to indicate that the patient's personal obligations would have no bering on their decision to refuse treatment. So long as they have the mental capacity to do so, their decision should be honored by the medical practitioners.
What odds of recovery would be good odds?
The odds of recovery for the operation were said to be one in seventeen. These odds are very low. For this reason, there does not seem to be much of an ethical dilemna in allowing her to refuse the surgery. Afterwards, her quality of life would be much lower and there would be a twenty-five percent chance of making it through the surgery alive and the same odds would have her being crippled afterwards. Fifty-fifty odds would be much better than this, but would still be difficult grounds to make the decision on. In this sense, the opposite, a seventy-five percent chance of success and a twenty-five percent chance of being crippled afterwards would be much better odds than what she is presented with. In this case, it seems that the odds are simply too low for her to make the decision to have the surgery. There is not much of an ethical consideration on the part of the healthcare provider due to the low odds and high risks associated with the surgery..
Does Mrs. S.’s apparent denial of her condition make informed consent impossible?
The main issue of this case is whether Mrs. S can be considered to be mentally competent to make the medical decision for herself. The idea of mental competence is, therefore, essentially to understanding the case. In the eyes of the law, the idea of mental competence essentially refers to the idea that the “patient can understand the risks and benefits of the proposed treatment, and the patient is able to make an informed choice” (Standler 6). In this case, it is not necessarily in question whether or not Mrs. S fully understands the treatment that is being offered. It is indicated that she seems to understand both the risks and benefits of the surgery as well as any potential harm that might be the result. Her refusal of the treatment is, therefore, not based on an inability to comprehend the information being presented to her. For this reason, informed consent is not impossible in this case. The care giver should take into account the desires of the patient in this regard but should also attempt to provide her with the necessary information for her benefit.
This is evident when accounting for the legal doctrines regarding a patient's decision being based on fear of an operation. An individual's fear resulting in their refusing specific medical advice or attention cannot be used to demonstrate that they do not have the mental fortitude or rationality to make the decision themselves (Bassman 2005). In this sense, it is evident that “while the refusal may be irrational and foolish to an outside observer, it cannot be said to be incompetent in order to permit the State to override the decision” (Standler 8). Her fear or psychological reserve in opting for the surgery are, therefore, not grounds for justifying the notion that informed consent is impossible in this case (Davies 2001). Rather, the fear should be considered a legitimate psychological response to the risks that are posed by surgery, no matter how small they may seem.
Is the physician ethical in reducing her anxiety about her apparent refusal of treatment when the physician believes treatment is medically indicated?
The basic duty of a physician is to both find and alleviate conditions in their patients. It is, furthermore, their duty and obligation to attempt to provide their patients with the most beneficial treatment possible. In this case, while the doctor is not able to provide her with the physical treatments that are most appropriate for her, he is attempting to provide her with the most adequate information so that she will be able to make the decision for herself by exercising her informed consent. In this way, so long as the information that the doctor is providing to their patient is accurate, and he truly believes that the operation is in her best interest, then attempting to reduce her anxiety about the operation in order to help her attain the best treatment is an ethical practice. The physician's regard for their patient, in this sense, seems to be for their well-being, as the operation is affordable and the chances of success are much higher than in the previous case. For this reason, it seems to be the doctor's priority to attempt to counsel their patient until they agree to seek the most effective treatment possible. This demonstrates the challenges that the doctor faces in regards to their ethical obligations towards the patient in this case. In living up to his obligations to provide his patient with the options that are best for their well-being, it seems evident that he has the responsibility to attempt to alleviate the fears that Mrs. S has so that her health will improve and she will be better off in the long run, as her spouse is healthy as well.
Bassman, R. (2005). Mental Illness and the Freedom to Refuse Treatment: Privilege or Right. Professional Psychology: Research and Practice. 36(5), 488-497.
Carrese, J. (2006).Refusal of Care: Patients’ Well-being and Physicians’ Ethical Obligations. d) JAMA, 296(6), 691-695.
Davies, T. (2001). Informed consent in psychiatric research. The British Journal of Psychiatry. 178 (5), 397-398.
Kleinman, I. (1991). The Right to Refuse Treatment: Ethical Considerations for the Competent Patient. CMAJ. 144(10), 1219-1222.
Standler, R.B. (2012).Legal Right to Refuse Medical Treatment in the USA. RBS. Retrieved From www.rbs2.com/rrmt.pdf.