According to Women’s Health Resource (2011) “breast cancer is a serious issue that will affect almost every women worldwide, either directly as someone diagnosed with cancer, or indirectly through the illness of a loved one”( Home, para. 1). In the United States breast cancer is the found in women in their early twenties and thirties. These individuals are more prone to breast cancer because she has a family history of breast cancer. In 2006, approximately 212, 920 new cases of invasive breast cancer were diagnosed in the United States (Women’s Health Resource, 2011). The case scenario below will discuss ethical and legal issues regarding a female patient with breast cancer, which refuses treatment for breast cancer. Additionally, the scenario will cover the following four ethical principles: respect for persons/autonomy, justice, beneficence, and non-maleficence that relates to the case scenario (Bishop, 2003).
A 25-year-old female patient made an appointment with her primary care physician because she discovered a lump on her breast. She went to her appointment with her primary care physician the following day. The physician examined her breast and discovered a lump on her breast, so he made a referral for her to see an oncologist in which can diagnose her if she has breast cancer. An oncologist is a medical doctor who specializes in the diagnoses and treatment cancer (The Denise Roberts Breast Cancer Foundation, 2009). The following are the three main types of oncologist: medical oncologist, radiation oncologist, and surgical oncologist, which can practice in hospitals and research centers. The female patient can make an appointment with the oncologist in which he will inform about her condition and different types of treatments available to her in which can reduce her chance of death as well conduct a biopsy. The biopsy will determine if she has breast cancer. The ethical issues are very clear, and they are respect for autonomy and beneficence. Additionally, the legal or ethical principles involved with breast cancer are no different from any other medical treatment/intervention.
Autonomy and Informed Consent
As stated by Bishop (2003), “respect for persons/autonomy is that a physician acknowledges a person’s right to make choices, to hold views, and take actions based on personal values, and beliefs” (p. 7). In order for an adult to refuse treatment, he or she must be legally and mentally capable by meeting the following criteria: 18 years or older, understands the nature of the condition, and voluntary. Additionally, parents with children under the age of 18 have the right to consent to treatment as well refusing treatment for his or her child. As recognized by Miller et al. (2000), physicians have a moral and legal obligation to comply with a patient’s voluntary, informed refusal of life sustaining treatment, regardless of a physician judgment concerning the medical or moral appropriateness of this.
In the case of the 25-year-old female patient with breast cancer she rejected medical treatment and was informed by the oncologist about the terminal illness. Death is seen as failure, rather than an important part of life (Smith, 2000). A conflict can arise with the patient because of the decision she made about not receiving care, which can likely end her life. The oncologist is obligated to inform or educate the patient about breast cancer, benefits of treatments, and risks involved with no treatment. The following are treatment options for cancer patients: lumpectomy, mastectomy, chemotherapy, radiation therapy, and surgical reconstruction (Women’s Health Resource, 2011). Although a physician can suggest benefits of any type of treatment the patient has the freedom to choose if he or she wants the treatment as well as ensuring the patient understand his or her own condition.
When a patient refuses treatment for breast cancer or any medical condition, the issue of autonomy becomes difficult because of the serious health consequences. The health care professional will offer the patient different options for treatment when this occurs. As stated before the physician should consult with the patient about his or her decision because nurses have ethics and codes of conduct in which he or she must follow. Nurses must care for patients while taking care of him or her as well as respecting and supporting the patient rights to decline treatment at anytime (Stringer, 2009). Medical professionals should respect the autonomy of patient decisions because it is a critical in the health care industry.
Rosenthal (2006), the principle of beneficence means that the health care provider must promote the well-being of patients and avoid harm them. Once a patient refuses treatment the health care professional must communicate the harm associated with no treatment for his or her condition. This can play a major role in how beneficence and maleficence is judged. When a patient has breast cancer and refuses treatment there is not another alternative option for the patient. During this principle the health care professional should ensure that he or she is maximizing possible benefits for the patients and minimizing harm when dealing with treatments. The health care professional can suggest certain treatments but the patient does not have to receive any care for his or her condition. When this occurs the physician will focus on different conflict resolutions for the care as well as services. A health care professional job is to offer quality of care to the patient in which he or she will benefit from the medical treatment.
During this principle, the health care professional will act with compassion when informing the patient about the potential benefits and risks for any medical condition. A patient is reliant upon the health care professional for someone who is caring and willing to share in the responsibility as well as treating him or her with dignity and respect. The 25-year-old female does not want treatment in which makes it hard for the oncologist to provide quality of care during the consultation and care.
Rosenthal (2006), during this principle, the health care provider ought to strive not to inflict harm to a patient, a requirement also seen as a duty not to refrain from aiding a patient. In addition, this principle will coincide with beneficence because it is reducing the harm to any patient although a patient refuses care/treatment. The health care professional is obligated to help the patients to the best of his or her ability by providing benefits, protecting the patient’s interest, and promoting welfare. Additionally, how, and what the health care professional does for a patient should have greater chance of benefiting the patient than harming the patient. This is done by risk benefit analyses, where the health care professional can conduct research on the condition and different medications. The health care professional should explain any side effects for treatments as well as medications that the patient will become knowledgeable about options for his or her condition.
The principle of justice means to treat others equitably, distribute benefits/burdens fairly (Bishop, 2003). In addition, it is very important for the health care professional to keep a patient informed about treatments and he or she should not provide misinformation to the patient. A major issue with this principle is economic barriers can interfere with a patient when trying to receive treatment and medication. The health care organization is required to provide services/care to a patient regardless of health care coverage, especially the uninsured In addition, the department should that all patients are treated equally regardless of age, race, and ethnicity. Additionally, this principle will focus on justice, which will provide care/treatment regardless of the patient demographics or ethical issues he or she encounters with the health care professional. During this principle, the patient is treated with dignity and respect even though he or she refused care/treatment for any medical condition.
Refusal of care is one of the most common ethical dilemmas in the health care industry, which is often difficult to resolve when his or her well-being is threaten. The health care professional must determine, which aspects of autonomy, beneficence, justice, and non-maleficence a patient want before providing care. Administrators within a medical facility must examine the following underlying issues: competence of a patient, the distinction between apparent, and real refusal of care (Michels, 1981). A physician has the legal duty to provide and ensure the patient with sufficient information about treatment and care when he or she is at the facility. Additionally, an ethical dilemma will exist because of a patient’s right will conflict with a physician obligation of providing quality of care to an individual. This was the case with the 25-year-old female with breast cancer.
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