In order for the interests of family members to be taken into account in medical decision making, I think that two principles have to be balanced. I think that patient autonomy and respect for persons have to be a part of every medical decision that an individual makes. The two principles are obviously going to come into conflict with one another in the decision making process, in which case autonomy should have more weight over the respect for persons principle.
I do not agree with John Hardwig's presumption of equality. Humans are just not wired to think that way, and the decision making process would become much too complicated as physicians became involved in the dynamics of families, attempting to morally and equally weigh the interests of patients and their families. Physicians have enough to consider as it is, as it is difficult enough determining which treatments and options will best benefit each patient's values and interests. Hardwig had the moral reasons for presumption of equality, but no solid explanations as to how the principle could be implemented. Patient autonomy would have to be sacrificed in order for the idea of presumption of equality to be honored.
I think that the interests of family members and those close to an individual should always be taken into consideration, but not necessarily given equal importance. Naturally family members can persuade, support, and participate in discussion and the joint decision making process, but when there is a conflict between autonomy and respect for the interests of family members, autonomy wins out.
The role of the physician, then, should be to respect patient autonomy by discussing possible treatments and providing all of the necessary information the patient needs to make an informed and autonomous decision as usual. In addition to this responsibility, doctors ought to also be trained to initiate discussion with the patient of their rights and responsibilities and encouraging patients to...
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