Bioethics is disoriented, non-verbal and requires a nasogastric tube

Bioethics
is a narrow, yet interdisciplinary branch of ethics focusing on issues concerning
biological and medical sciences (Kuhse,2015). It is becoming increasingly relevant
in current healthcare practice since previous moral obligations of healthcare
professionals and society are being reconceptualised with rapid scientific,
technological and social developments (Beauchamp et al.,2001). A concept central to bioethics is principilism
–an approach aiming to solve modern healthcare dilemmas by using principles of patient
autonomy, beneficence, non-maleficence and justice as a framework (Lawrence,2007).

Through this paper, it will be argued that autonomy is the most important
factor when making patient-related healthcare decisions since it allows for care
which aligns with patients’ self-image, provides patients the power to dictate
what is good or bad for them, and permits culturally sensitive medical practices. 

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 Autonomy is the idea that individuals have the
right and ability to act on their opinions in a manner consistent with their
personal values and beliefs. In medical practice, this principle roughly
translates through informed consent, which is to provide information to
individuals to aid them in making voluntary and informed medical decisions
(Nanu et al.,2015). Primarily, respecting a patient’s autonomy means respecting
the patient’s self-image since it is inclusive to their beliefs and values (Varelius,2006). It
creates a collaborative, high trust patient-physician relationship experience
rather than one which is oppressive and authoritative (Entwistle et al.,2010).

 

Imagine a patient
is disoriented, non-verbal and requires a nasogastric tube for nutrition and
fluids due to a massive stroke. She fought against the tube insertion and often
finds ways to remove it. Should measures be taken to replace the tube every
time? Under autonomy, continual replacement of the tube is a violation of the
person’s beliefs regarding how she wishes to live or die. She may continue
living, but the satisfaction gained is questionable. Through her actions, it
can be inferred that she does not wish to sustain her life via tubes. Perhaps
at this stage in her life, she values the idea of living less than the idea of
dying peacefully, unattached to machinery. The medical professional’s duty is
to present options, sufficiently inform her to these options, and respect the
choice she makes based on her beliefs (Nanu et al.,2015).

 

If the
principles of non-maleficence or beneficence were primarily used to guide decision-making,
the patient’s wishes would be secondary to society’s standards of “do no harm”
or “do good”, respectively. Non-maleficence is defined as the practice of avoiding
harm and/or the risk of harm (Beauchamp et al.,2001). Although,
with medicine’s intrinsic nature to bring harm, minimizing or reducing harm is
a better definition (Gillon,1994). Meanwhile, beneficence refers to the
obligation to do good and act in the best interest of patients (Nanu et al.,2015).

The obligation to ‘do no harm’ such as performing unnecessary surgery is
distinguishable from the obligation ‘to do good’ such as providing life-saving
medication.

 

Oftentimes,
societal values informing the criteria for harm and good may not align with the
patient’s personal belief system. According to societal standards, for the
aforementioned case, harm occurs when care is withheld, as this leads to
unnecessary death, while doing good would be to continue re-inserting the tube
every time it is taken out. However, the definition of doing harm and doing
good is highly subjective and should be set by the patient since they are the
ones who can truly understand their personal experience. They are a better
judge for their health outcomes since they best know what aligns with their
values and beliefs. In essence, beneficence and non-maleficence are only truly practicable
when guided by autonomy.

 

Additionally, autonomy
makes it possible for patients to engage with culturally or
religiously-sensitive medical practices. Patients who distrust or fear Western
medicine can refuse treatment in favour of traditional healing methods even
though the practices lack scientific evidence (Nanu et al.,2015). However, autonomy
can become problematic when the patient is a minor. Since children are not
mentally mature, they heavily rely on their parents to help make medical
decisions. The parents can many times refuse specific treatment on cultural,
religious and philosophical grounds (Mikayla…treatment,2015). For example,
blood transfusion is refused by parents of a nine-year old boy who are
followers of the Jehovah Witness faith. In such cases, autonomy is compromised
since the patient is incapable of providing consent or making the decisions.

 

Moreover,
respecting autonomy is problematic when decisions made by patients can
influence other members of the healthcare system. Consider a terminally ill
cancer patient who is being treated using a rare, expensive drug. The treatment,
and others, had little success and it is time to consider palliative care.

However, the patient wishes to continue fighting the disease and is not ready
to give up. Medically, no option remains and continuing with treatment might be
more harmful to their health. Respect for autonomy informs us that the patient
should be given the option to continue treatment. However, under the principle
of justice, a different opinion arises. Justice is helpful in guiding decisions
related to the distribution of scarce healthcare resources, respect for
people’s right and respect for morally acceptable laws (Beauchamp et al.,2001). When considering the allocation of resources, it is not only
important to provide sufficient healthcare to meet the needs of the people
requiring it, but also to maximize the benefit of the resources while not being
burdensome to taxpayers (Gillon,1994). Allowing continued treatment does not fulfill
these requirements. The drug is a strain on the health budget and Canada’s
public healthcare system due to its high cost, while suboptimal usage of the
limited drug makes it unavailable from someone else in need. In cases where
there are additional stakeholders to the traditional patient-physician
relationship, it is difficult to say that decisions should be primarily guided
by autonomy.

 

            All
things considered, respect for patient autonomy is the most important since it
allows for decision-making which is inclusive of the patient’s values and
beliefs. It provides patients the power to direct their own healing journey by
allowing them to define what they consider to be positive or negative outcomes
of health. Nevertheless, it is not without its flaws since it is harder to
respect patient autonomy when decisions are made by a parent/legal guardian or
when the medical decisions can impact other stakeholders within the healthcare
system.

 

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