Medical Paternalism or Patient Autonomy
At issue in the controversy over medical paternalism is the problem of patient autonomy. Medical paternalism can be defined as interfering with a patient’s freedom for his or her own well-being; patient autonomy means being able to act and make a decision intentionally, with understanding, and without controlling influences (Munson, 38 & 39). The principle of informed consent has come to be essential to any philosophical analysis of the tension between medical paternalism and patient autonomy in healthcare decision-making. However, despite the obligatory duties physicians have to their patients, patient involvement and informed consent should be valued in certain medical cases. Consider, for example, the case of Monica, a 49-year-old woman who was admitted to the hospital for acute respiratory insufficiency. As a heavy smoker, she had been experiencing dyspnea. Upon examination it appeared she had several abnormalities in the chest. Following this she became cyanotic and nearly lost all consciousness. Furthermore, a bronchoscopy revealed a large, tumor-like mass in her trachea. Upon further examination it was determined by a multidisciplinary treatment team that Monica was so advanced in the tumor, removing it would not be possible, either by surgery or laser. In addition, chemotherapy and radiation therapy would not have helped and implanting a stent would have been difficult. Monica had at most three more months to live. With such factors taken into consideration, the team devised four possible alternatives: remove life-sustaining measures, continue mechanical ventilation and heavy sedation without treating any complications, implant a stent without Monica’s consent, or wake Monica and inform her on the diagnosis and possible alternatives while giving her the final choice. However, the team does not believe that Monica will have the full autonomy to make a rational decision on her own. Furthermore, the team worry...
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