Healthcare sector
In the healthcare sector, medical professionals are trained in understanding and ensuring they respect the patient’s wishes. This is not just their duty but it is also an ethical obligation for the healthcare providers. The patients are expected to be in a position where they can make informed decision and give consent to treatment. It is through the principle of autonomy that healthcare providers are expected to allow the patients to decide on the direction of the treatment. Through understanding of the details the patient agrees to have a procedure done which then saves their life. The patient can choose or fail to choose the recommended treatment. Allowing the patients to make such decisions and having the medical professionals action them shows great respect to the wishes of the patients. Doctors should, however, evaluate the patients’ conditions and understanding when deciding to respect their decisions. Autonomy and self-rule may seem advantageous but may be limited due to various circumstances surrounding the patient.
The principle of autonomy is based on the principle of respect for individuals and the notion that people have the right to make their choices and map out a plan for their life. In the healthcare setting, this principle is the principle of informed consent. This means that the doctor is not allowed to treat the patient without their consent or a surrogate appointed lawfully (Childress & Beauchamp, 2001). This means that the doctors have to discuss treatment options or preferences and document them in the patient’s charts. While considering the treatment, the doctor has to ensure that they use a language that the patient or the surrogate understands. The capacity to comprehend is paramount for an individual to make an informed decision.
Several requirements are necessary for informed consent to happen. The patient and the surrogate, as mentioned earlier, must be competent and can understand the consequences of their choice. This means that the patient or the proxy must be free to make a choice. There should be no undue influence or coercion on the patient or the surrogate (Childress & Beauchamp, 2001). Still, the healthcare provider should ensure that they provide all the necessary information needed to make informed consent and must ensure the patient understands the information. The patient’s understanding can be evaluated through reflective conversation with the doctor or healthcare provider (Childress & Beauchamp, 2001). The signing of any waiver, which may be seen as informed legal consent, does not meet moral standards. This is because the signing of the waiver prevents the patient from changing their minds later.
To term, a patient as competent the patient or surrogate has to understand they are authorizing medical treatment, and they are aware of the treatment and the effects the treatment would have. In most cases, adult parents are assumed to be content enough to make informed decisions on behalf of their children (Childress & Beauchamp, 2001). Competence is also deemed relevant when the patient can make decisions specific to a precise treatment and the issue at hand. However, the standard of competence should be set highest when the consequences of a precise treatment are more extensive. The primary way that competence can be determined is by having the health care provider spend more time with the patient and understanding the patient’s mind and comprehension (Childress & Beauchamp, 2001). This means looking at the patient’s ability to express their understanding of the situation, express their preference, and understand the inherent consequences.
While the autonomy principle is detrimental in the healthcare provider’s work, the ability of a patient to make informed consent is not always possible. The healthcare provider may engage the patient on the interventions, risks, and benefits involved and expect the patient to make an informed decision on the information provided.
However, the nature of this information may be such that the patient’s decision making and understanding become overwhelmed, rendering the ability to make informed approval impossible (Bester, Cole & Kodish, 2016). While the physician has the duty to respect the patient’s autonomy, there are other ethical obligations that they have to the patient as well as all other. The primary duty is to no harm. Therefore when the patient’s autonomy is not possible, the healthcare provider’s other ethical commitment should still be discharged (Bester, Cole & Kodish, 2016). This means that the healthcare provider should move priorities from informed consent to protect the patient’s life.
When assuming informed consent, capacity is a prerequisite for the patient. This is the ability to deliberate and compare the risks and benefits of the procedure. However, capacity can be a sliding scale whereby the patient may have the capacity to make some decisions and lack in making others (Bester, Cole & Kodish, 2016). As mentioned earlier, when the stakes of the decision making are high, then the threshold in which a patient is considered to have capacity is also deemed higher. The patient should demonstrate a more exceptional ability to reason the complex medical information provided (Bester, Cole & Kodish, 2016). Instances where the patients lack the capacity to make informed decisions, the healthcare providers do not continue to seek consent for their patients. For example, an unconscious patient lacks capacity, and the healthcare provider would, therefore, presume consent and administer emergency treatment.
Another factor that can inhibit informed consent or the autonomy in a patient is distress and confusion in patients. In cases where the patients are severely ill, their main focus is often on their recovery ad treatment. This makes them anxious and may find it disturbing when they are being informed about a study or a new form of treatment (Rebers, Aaronson, van Leeuwen, & Schmidt, 2016). Stress makes it difficult for the patients to grasp the rationale behind the study or the treatment, especially when the decision has to be made in an emergency. Still, on occasions when the patient suspects that the doctors are not sure which treatment is right or are not sure if the success of the treatment, then the patient may not be able to make an informed decision (Rebers, Aaronson, van Leeuwen, & Schmidt, 2016). It is paramount for the doctor to maintain the relationship with the patient in such cases as trust is needed.
Still, informed consent is limited for individuals who are under constraint or are unable to refuse others’ demands. The most vulnerable group in this instant includes prisoners, soldiers, and dependents (O’Neill, 2003). These groups of people have the capacity for consent, but they cannot make decisions. This undermines the individuals’ ability to consent, for instance, in teenagers who understand the information provided by the doctors and the risks involved but would like to give their consent. The parents, however, may fear the risks and opt not to give their consent. Given that the teenagers are dependents, the doctors or the physicians have to follow the parents’ decisions, and the parents’ consent may not count.
Still, other factors can influence the ability to make an informed consent. One of these factors is language barriers which create a problematic scenario for the physician to assess the patient’s ability to make an informed decision (Nijhawan et al. 2013). Lack of adequate language translation or incorrect translation can lead to the assumption that the patient fails to understand what the treatment entails. In clinical trials, patients are assumed to sign the consent forms because they understand what the trials entail. Due to language barriers, the patients are withdrawn during later stages (Nijhawan et al. 2013). The burden in such cases falls on the researchers and doctors to ensure that the patients are fully aware of what these studies and treatments entail. Adequate translations are needed before subjecting patients to any treatment or clinical trials. However, in emergency treatment cases, the physician must assume consent and perform their ethical obligation to do no harm.
Autonomy and self-rule may seem advantageous but may be limited due to various circumstances surrounding the patient. Autonomy is the basis of informed decisions. The ability of a patient to make an informed decision depends on their capacity to comprehend the information provided the risks and the benefits of the treatment. Factors such as language barriers, the patient is unconscious, and even a situation where the patient is unconscious or unable to make decisions limits the patient’s autonomy. In emergencies, the healthcare providers also have the ethical duty to do no harm, which at the time surpasses the duty to autonomy. However, in other cases, physicians are obligated to interact with the patient. They do their best to ensure that the patients fathom the information provided to make knowledgeable decisions.