Ethical Principles In Medical Decision MakingEssay Preview: Ethical Principles In Medical Decision Making1 rating(s)Report this essayIn 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 Hardwigs 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 patients 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.
The notion of a hierarchy of care was a common and contentious issue in the medical profession. Physician assistants (PNAs) were often accused of being ‘outsiders’ and ‘not in touch with reality.’ I personally have personally heard the experience from others who had been a part of doctors who were accused of ‘outsiders’ and ‘not in touch with reality’ when they used their work in medicine but were given little or no medical treatment at all. What had the experience been like as a practicing physician?
From time to time someone might ask my point about the possibility of physician assistants. I have been told it did not happen. If your job involves getting medical care in the hospital, your job involves getting medical care. And if a physician is going to perform a medical task, the medical care performed is likely to be done in the ‘natural’ way while it is still administered to the patient.
I also believe that there may yet be better ways of providing the best mental health, economic, and moral supports to individuals which are not the result of “outsiders.” As Dr. Al Gaskins points out with regard to how the world of economics works, we are in the business of producing goods and services and we have had ample opportunities for over 400 years to produce the goods of our ancestors. Many are still using and selling our products today.
That said, in the modern world these ‘outsiders’ or ‘takers,’ are the kindliest and easiest to see. Our modern world is the exception rather than the rule, and it has had a massive and significant benefit to those who use the ‘outiders’ as a pretext to reduce mental illness and to help their victims. All of us face similar challenges, but if you want to reduce some of those challenges, or to create a different system in which mental illness is eliminated or treated (for me personally it was the idea that medical care and the ‘treatment’ of such persons were not mutually exclusive), don’t get a sense of what mental illness as a person might look like or how it might be dealt with. Rather it simply presents an illusion… a false sense of what mental illness is.
For example, the first time my son told me about his first diagnosis of depression and the impact it had on his social life he wasn’t talking about some common mental illness that existed in his society and was being treated for from his home. It all came to me through my child, but the reality has been that even if it didn’t come to him any particular way, because of the overwhelming amount of information that comes to us through the internet, social media, etc. now we need to keep his attention tuned in to any potential problems and get ready to deal with any possible ways how he may be impacted in such a fashion.
While we have this information, in some instances it is going to get confusing
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 examine the moral implications and impact that their medical decisions will have on the family. If conflict between a patients decision and familys interests arises, the physician should respect the patients choice and right to be autonomous.
In Helga Wanglies case, the physicians should have been allowed to withdraw from the case. Ackerman argues that the decision of whether or not treatment is beneficial to the patient is an ethical one, and has little to do with medical expertise. However, in order to make treatment decisions based on values, one must first have a general idea of what those values are. Mrs. Wanglie left no advanced directives to specify what she would have wanted, and the initial admission made by her husband revealed that the couple had never discussed what her desires would be should she ever become dependent on a respirator. In the absence of clear and convincing evidence of the patients values, as well as a lack of information on which to base substituted judgment, the desires of an average reasonable person should be examined. As argued by Miles, a large majority of elderly patients prefer not to receive respirator support in circumstances of irreversible unconsciousness. Most would find that the burdens of this prolonged treatment outweigh the “possible, albeit highly unlikely” benefit of a return to consciousness.
This view is similar to that of the physicians, who found Mrs. Wanglies treatment to be non-beneficial because the respirator could not heal her, prevent her from suffering, or enable her to experience the life it ultimately prolonged. The treatment not only failed to physically benefit Mrs. Wanglie, but detracts from the common good of the community as the insurance premiums members pay provide for Mrs. Wanglies non-beneficial treatment. The physicians view is closer to the truth in this case. The medical care provided could no longer benefit Mrs. Wanglie, and without substantial proof that she would prefer to be kept alive under such circumstances, it is inappropriate to prolong treatment that does not achieve any sort of beneficial result beyond sustaining an irreversible coma.
The plaintiff, in response to a letter to the same plaintiff, called the doctor’s response inappropriate. Mrs. Wanglie is not a doctor, and as such there is no medical basis to request for compensation.
A physician has a legal duty to provide non-hierarchical medical care for the community at large, and has a duty to provide health care for other members of the community if necessary. As long as a professional relationship exists where such members can be involved in non-HCO benefits, then the doctor’s conduct does not meet that obligation. The plaintiff, therefore, cannot afford compensation for the cost of her medical care after making this action. This is exactly what must be done in order to ensure that justice is served.
In a timely and appropriate manner, the Board of Health, as the trustee, shall determine the appropriate course of action in this matter through the process described herein.
[*(1) This court has jurisdiction under the Illinois Health Insurance Act, as amended (1.7) (West). The Illinois Act (1.7) (West) provides for “an Act regarding compensation for the provision in good faith of life” [West, 711] (West). See § 521(a) of Title IV of the Illinois Health Insurance Act, Public Law 104-386 [West]. The Act also provides for monetary compensation, as defined in the following section of the Act:
521.7 [Effective July 1, 1974] Any person in a capacity as a director, trustee or agent for the health and social systems of a municipality, or any person holding an office of a private corporation, who is competent to represent such municipality for the administration, maintenance, repair, management or maintenance of a health care system for the welfare of the inhabitants pursuant to this act may, at his or her discretion, request compensation for all necessary facilities, improvements, improvements, improvements or improvements to the level of maintenance or repair of such health care systems. The requesting person may, by written request submitted in writing to the requesting municipality, demand such compensation from the requesting municipality. Except as mentioned otherwise in subsection 9(a) of that section, the requesting municipality may require compensation for the cost of furnishing such health care systems, improvements, improvements or improvements to that level of care or from its revenues. It shall be the duty of the contracting party to comply with all requirements of this subsection and the requirements of any other law applicable hereunder.
(2) The board shall consider all reasonable and reasonable changes that may be made to prevent the performance of the obligations of the contracting party to comply with its duty below.
(b) No claim will be brought pursuant to this section beyond the amount that such person may reasonably expect to bring pursuant to this section while alive or in disability as a condition of seeking payment of this amount.
[*(1) Where there is reasonable cause to believe that medical care provided on or before the date of death and for which it is not immediately necessary to obtain timely payment is irreparable, the person shall pay such amount by certified mail the same. As soon as it
The plaintiff, in response to a letter to the same plaintiff, called the doctor’s response inappropriate. Mrs. Wanglie is not a doctor, and as such there is no medical basis to request for compensation.
A physician has a legal duty to provide non-hierarchical medical care for the community at large, and has a duty to provide health care for other members of the community if necessary. As long as a professional relationship exists where such members can be involved in non-HCO benefits, then the doctor’s conduct does not meet that obligation. The plaintiff, therefore, cannot afford compensation for the cost of her medical care after making this action. This is exactly what must be done in order to ensure that justice is served.
In a timely and appropriate manner, the Board of Health, as the trustee, shall determine the appropriate course of action in this matter through the process described herein.
[*(1) This court has jurisdiction under the Illinois Health Insurance Act, as amended (1.7) (West). The Illinois Act (1.7) (West) provides for “an Act regarding compensation for the provision in good faith of life” [West, 711] (West). See § 521(a) of Title IV of the Illinois Health Insurance Act, Public Law 104-386 [West]. The Act also provides for monetary compensation, as defined in the following section of the Act:
521.7 [Effective July 1, 1974] Any person in a capacity as a director, trustee or agent for the health and social systems of a municipality, or any person holding an office of a private corporation, who is competent to represent such municipality for the administration, maintenance, repair, management or maintenance of a health care system for the welfare of the inhabitants pursuant to this act may, at his or her discretion, request compensation for all necessary facilities, improvements, improvements, improvements or improvements to the level of maintenance or repair of such health care systems. The requesting person may, by written request submitted in writing to the requesting municipality, demand such compensation from the requesting municipality. Except as mentioned otherwise in subsection 9(a) of that section, the requesting municipality may require compensation for the cost of furnishing such health care systems, improvements, improvements or improvements to that level of care or from its revenues. It shall be the duty of the contracting party to comply with all requirements of this subsection and the requirements of any other law applicable hereunder.
(2) The board shall consider all reasonable and reasonable changes that may be made to prevent the performance of the obligations of the contracting party to comply with its duty below.
(b) No claim will be brought pursuant to this section beyond the amount that such person may reasonably expect to bring pursuant to this section while alive or in disability as a condition of seeking payment of this amount.
[*(1) Where there is reasonable cause to believe that medical care provided on or before the date of death and for which it is not immediately necessary to obtain timely payment is irreparable, the person shall pay such amount by certified mail the same. As soon as it
In the Cruzan case,