Ethical argument essay
Decisions are being made numerous times in a health care setting which are related to patients’ health and as health-care professionals we are guided by moral principles, However, a conflict between moral principles causes ethical dilemmas which can be witnessed in several cases.
A case published in 2017 explained a scenario that encompassed an ethical dilemma when a patient refused medical assessment/ treatment. A patient was given referrals for a urologist secondary to hematuria and flank pain. However, the patient refused to schedule an appointment because he did not want to be catheterized or have a prostate exam. Upon following up and re-emphasizing the importance of the referral the patient still refused until his symptoms worsened and was then diagnosed with Stage IV renal cell carcinoma (Management, 2017) Health care professionals face this ethical dilemma where patients refuse treatment, even if it is in the patient’s best interest (Marco, 2017).
The ethical issue in this case is between autonomy and beneficence. The patient refused to be treated and all though the PCP emphasized the importance he failed to ensure the patient got treated in a timely fashion. The PCP ultimately allowed the patient to decide, but should he have focused more on beneficence and been more persistent with the patient? I believe according to the core principles that should be followed by a PA, the ultimate decision to be seen by a specialist after learning about the risks/benefits should be the patient’s decision.
According to AAPA there are four main bioethical principles – autonomy, beneficence, nonmaleficence, and justice (A, 2013). Autonomy refers to self rule and that patients need to be involved at their level of choice to make a health related decision. Patients have this right and as a PA we need to respect the patients ultimate decision. Beneficence states that a PA is required to make decisions that take into consideration the patient’s best interest and is also referred to as the act of doing good. However, these can clash which makes it difficult to balance each principle (A, 2013).
Patients are ethically and legally allowed to choose their treatment. However, two conditions that exist with this autonomy is that patients need to be competent/ mentallly capable of making decisions and “free from external constraints” (TheBMA, 2020). In this case as PA I would attempt to create a balance with both principles – autonomy and beneficence. By having an open discussion with the patient, I would explain the benefits of the treatments/assessments and what the risks of refusal are. I would attempt to reframe the patient’s attitude towards the referral with facts. Additionally, with permission I would attempt to explain the situation to a family member or legal guardian. However, ultimately I would allow the patient to make the decision and respect it. It is not possible to force patients to be treated and as PA I should respect patient preferences, therefore the PA’s obligation to autonomy outweighs beneficence.
On the other hand, one can argue that as a PA, guidelines state that the “ primary responsibility for the health, safety, welfare, and dignity of all human beings” and that is something we should follow (A, 2013). Even if the patient qualifies to make autonomous decisions, the patient may be incapable of understanding the medication information that will allow him/her to assess risks/benefits. (Valerius, 2006) A trained healthcare professional is more mature and experienced and may be able to better determine what serves patients the best. By placing more importance on autonomy vs beneficence in this case, as a PA we forgo our primary responsibility of health for all human beings.
The importance of autonomy outweighs that of benefince. A patient has an ethical right to decide the trajectory of their life. As PA we cannot forcibly give a patient treatment. However this is contingent on patients competency and the healthcare professionals to fulfill their responsibility and fully explain the benefits and risks. Assessment/ treatment is not obligatory.
References
A. (Ed.). (2013). Guidelines for Ethical Conduct for the PA Profession. Retrieved June 11, 2021,
from https://www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf.
Management, N. R. (2017, July 05). When Patients Refuse Treatment: Medical Ethics Issues for
Physicians. Retrieved June 04, 2021, from https://www.norcal-group.com/library/
when-patients-refuse-treatment-medical-ethics-issues-for-physicians.
Marco CA, Brenner JM, Kraus CK, McGrath NA, Derse AR; (2017 November) ACEP Ethics
Committee. Refusal of Emergency Medical Treatment: Case Studies and Ethical
Foundations. Ann Emerg Med. 70(5):696-703.Doi: 10.1016/j.annemergmed.2017.04.015.
TheBMA. (2020, May 1). Autonomy or self-determination as a medical student – Ethics toolkit
for medical students – BMA. Retrieved from
https://www.bma.org.uk/advice-and-support/ethics/medical-students/
ethics-toolkit-for-medical-students/autonomy-or-self-determination.
Varelius J. (2006). The value of autonomy in medical ethics. Medicine, health care, and
philosophy, 9(3), 377–388. https://doi.org/10.1007/s11019-006-9000-z
