Medical Ethics: Patient Autonomy

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Table of Contents

Introduction
Discussion
Conclusion
References

Introduction

The current medical ethics are built on the principle of patient autonomy. This nursing principle presents a challenge for the healthcare industry as the patient intentions are not always reflected in treatment decisions when someone else must speak on their behalf is challenging. Decisions made by proxy are particularly unsettling when the proxy’s judgment may be affected by individuals’ self-interests (de Oliveira & Jacobson, 2021).

Discussion

This occurs when the proxy requests the patient’s therapy rather than the one the patient would have preferred. This problem of interested proxies is exacerbated as we seek out proxies who often have strong interests in treating the patient. Patients confer their proxy authority to close relatives as they are deemed fit to care for the patient as they are likely to want the best healthcare for the patient than others. Other reasons for choosing close relatives entail their closeness to the patient, which translates to general knowledge regarding the patient’s needs. This familiarity enables us to use the substituted-judgment criterion of proxy decision-making. The substituted judgment standard is an ethically superior basis for proxy decision-making to the reasonable-person or best-interest standard as it is committed to patient autonomy.

The alternative can be proxy decisions made by court-appointed guardians or ethics committees. These outsiders have self-interests; thus, their proxy decisions are likely influenced by these interests. In addition, outsiders rarely have pertinent information regarding the patient’s condition and are less concerned about the individual patient than close relatives (Shepherd et al., 2018). Family members’ self-interests often overlap with the patient’s treatment decisions, as they are intimately involved with the patient. This phenomenon leads to a dilemma where knowledgeable relatives have inherent self-interests, and outsiders lack the intimate knowledge required to render a reliable substituted judgment.

The current theory of proxy decisions is deeply flawed and must be changed to ensure improved patient outcomes. Physician’s recommendations are better than conventional theories of proxy decision-making as health practitioners only seek to improve patient outcomes. However, the healthcare sector must acknowledge that numerous treatment decisions inevitably affect the quality of more than one life. Patients affect the quality of life of caretakers and relatives as people get emotionally involved, and the treatment decisions have critical financial implications that affect the lives of the rest of the family (Rolland, Emanuel, & Torke, 2017). It is prudent for proxy decision makers to consider the consequences of treatment decisions on all those affected. The moral relevance of proxy decision-making leads to consideration of critical interests, which affects the quality of patient outcomes as the morally sufficient treatment is not the best treatment for the patient.

The assumption that substituted judgment is a morally acceptable criterion for proxy decision-making is unfounded since it can be ignored when treatment options impact a patient’s family. The only scenarios where substituted judgment is morally appropriate are when the treatment decision will only affect the patient or when the patient’s decision-making would have appropriately considered the interests of those whose lives will be impacted (Shepherd, 2022). This implies that decision-makers acting as a proxy can take actions that may go against a previously competent patient’s general preference.

Conclusion

The healthcare industry must address the possible challenges of biased proxy decisions by making these biases aware, transparent, and genuine. In addition, clinicians should offer direction and assistance to people who are confronted with making morally dubious proxy decisions. This strategy would reduce the number of improper proxy judgments.

References

de Oliveira, A. C. M., & Jacobson, S. (2021). (Im)patience by proxy: Making intertemporal decisions for others.Journal of Economic Behavior & Organization, 182, 83–99. Web.

Rolland, J. S., Emanuel, L. L., & Torke, A. M. (2017). Applying a family systems lens to proxy decision-making in clinical practice and research.Families, Systems, & Health, 35(1), 7–17. Web.

Shepherd, V. (2022). (Re)Conceptualising “good” proxy decision-making for research: The implications for proxy consent decision quality.BMC Medical Ethics, 23(1). Web.

Shepherd, V., Hood, K., Sheehan, M., Griffith, R., Jordan, A., & Wood, F. (2018). Ethical understandings of proxy decision making for research involving adults lacking capacity: A systematic review (framework synthesis) of empirical research.AJOB Empirical Bioethics, 9(4), 267–286. Web.

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Medical Ethics: Patient Autonomy

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