Basic Decisions Ethical Concepts

This paper will follow the ethical decision-making process for a 22-year-old male victim of a motor vehicle accident which resulted in a broken neck. The accident left the patient as a quadriplegic and after many months in painful rehabilitation with little progress, he asked that he be allowed to die by starvation while receiving only basic physical care and pain medications in the hospital. The physician refused to honor the request and ordered a feeding tube inserted to force-feed the client and keep him alive.

In the scenario above, the patient is competent and capable of making medical decisions for himself. A competent patient's right to refuse any recommended treatment is an important principle of informed consent (Menendez, 2013). This means that the patient has the ability to understand and process the information provided, appreciate the foreseeable consequences of their decisions, and make their decision or refuse treatment. Capacity can change over time and if the patient is thought to lack capacity, healthcare team members must consider assessing their competence and obtaining informed consent from a medical surrogate.

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(Badger, Ladd, & Adler, 2009).

Autonomy has become a dominate cornerstone in patient care. Medical personnel have to balance respect for patient autonomy with beneficence and nonmaleficence. Autonomy is the patient’s right to self-determination including accepting or refusing any medical recommendations or orders. Beneficence is to do good in our actions and nonmaleficence is, essentially, to do no harm. Often, those basic principles will collide but how do we know how to act during those ethical dilemmas? The definition for doing harm is subjective when we consider personal cultural and spiritual characterizations of the patient and the care staff.

Medicine is a customer service field and Joint Commission standards that require that patients participate fully in decisions about their care, treatment, and service (Menendez, 2013). Providing care and ensuring patient satisfaction while maintaining one’s own values will dictate how all health care personnel perform in all situations, including ethical dilemmas.

Autonomy is “self-rule, the ability to do as one wishes…” (Wais & Qarani, 2015). Autonomy is based in the Nuremberg codes of ethics and Helsinki declaration which functions to, as Professor Alexander Capron of the University of Pennsylvania Law School has identified as, promoting individual autonomy, protecting patients, promoting rational decisions, and provides legal protections. (Kour & Rauff, 1992) The patient is employing that right. His refusal of treatment except for basic physical care and pain medications shows forethought to the consequence of ending his life. While the scenario does not indicate that the patient was given or has considered alternative treatments (i.e. second opinions by other physicians, complementary or alternative medicine, experimental treatment, potential for medical advancements, assisted suicide, etc.), the patient has considered his rehabilitation progress. Despite the possibility that the patient has not made an informed decision, he has made his wished known with the expectation that they will be carried out. (Wais & Qarani, 2015). This is his right as the patient and the U.S. Supreme Court has maintained the right of voluntary consent to medical procedures, recognizing that an individual has a right to “control of his own person, free from all restraint and interference of others” (Horner, Modayil, Chapman, & Dinh, 2016).

The physician is acting on the basic principle of nonmaleficence. If he follows the wishes of the patient, he is denying him basic human necessities that can become the basis for litigation. The physician refused to honor the patient’s request and ordered a feeding tube inserted to force-feed the client. (Badger, Ladd, & Adler, 2009) Ultimately, all health care workers must make the judgment about values, providing care, risk of possible litigation, and compassion to fulfill the patient’s wishes. In California, the case of Thor v. Superior Court considered preserving life, preventing suicide, maintaining the integrity of the medical profession and protecting innocent third parties in determining the scope of patient autonomy but California has not implemented a policy of preserving life at the expense of personal autonomy so decisions are still subjective. (Horner, Modayil, Chapman, & Dinh, 2016). Being health care professionals, it is our prime responsibility not to harm the patient and to provide maximum benefit to the patient (Wais & Qarani, 2015).

Respect for patient autonomy and self-determination requires that decisions to consent to or refuse treatment originate freely from the patient as an autonomous agent. The granting of autonomy to refuse consent to a recommended treatment requires health care providers to accept the free choice of each person even if that choice seems inappropriate, foolish, or hazardous. (Menendez, 2013)