Medical Paternalism and Autonomy
Question One
Physician’s practices and attitudes that are not in line with the patient’s choices and wishes are referred to as medical paternalism. According to Vaughn (2010, 104), medical paternalisms has been a significant threat to the nursing industry, and specialist began putting measures to eliminate it towards the end of the 20th century. Previous authors have brought into the limelight that medical paternalisms impacts nursing practice adversely due to uninformed decision making and lack of respect for the patient’s interests. Vaughn (2010, 104) suggests that clinician’s intentions should be geared towards satisfying the patient’s demands; however, medical paternalism works contrary to the propositions of nursing practice. In the past, doctors did not see medical paternalism as an unfit ethical practice due to limited freedom of patents to the treatment practice. Vaughn (2010,106) opine that healthcare facilities are currently working towards the attainment of patient-centered- care in addition to honoring their demands due to the ever-increasing number of service providers.
When it comes to autonomy, healthcare administrators and the entire nursing team utilizes bioethical philosophy and physiology as well as moral aspects in making uncoerced yet informed decisions regarding patient care. Well-established nursing homes work independently to ensure that patient’s autonomy is achieved (Vaughn, 2010, 116). Vaughn (2010, 116) looks at independence from the human resource perspective in the sense that doctors work towards satisfying both patients and nurses. Previous research has confirmed that effective use of autonomy among healthcare facilities aids in attaining patient-centered care due to the official nursing activities. The recommended levels of independence among healthcare providers demand doctors consider morally-based principles. Vaughn (2010, 116) opines that autonomy requires self-actualization among physicians while minding the impacts of external expectations. Importantly, the nursing team should put more emphasis on culturally-based aspects related to patients. As such, patients will feel that their diverse cultural needs are respected.
Question two
Patients always wish to have a clear view of their progress as well as the outcomes of tests conducted. Revealing the truth is among the vital professional aspects in healthcare; however, it may harm the patients hugely (Vaughn, 2010, 156). As such, doctors should formulate methods of telling patients truth in such a manner that it does not bring immense harm. According to the exiting survey, most of the patients would want to know their remaining lifespan more so the terminally ill (Vaughn, 2010, 157). No ethically informed doctor would wish a patient to have such a line of thinking since it harms more than it can cure. Vaughn (2010,157) opine that doctors find it challenging to reveal some healthcare conditions to the patients, including advanced levels of cancer, genital ambiguity, and death of unborn babies. As far as the sensitivity of the above-listed cases is concerned, patients will demand to know the truth, a process that must be conducted tactically. Vaughn (2010, 158) provides a perfect example of a mother who was diagnosed with cancer in its advanced stage. Her children were with the view of advising the surgeon not to reveal the incidence to her due to harm it would cause. The children decide to inform the father about the incident, and the report worsened the situation even more. Precisely, the announcement shocked him in addition to developing a hostile relationship among the children and the surgeons (Vaughn, 2010, 159). The above example does not necessarily mean that truth should not be revealed to patients and their loved ones but should be done tactically. The tactical aspect is achieved by providing cushion to victims to ensure they adapt appropriately to the health condition facts (Vaughn, 2010, 158). Overall, patients will come to know about their health status in the long run, so doctors need to inform them will minding cushioning aspects.
Question three (300 words)
Informed consent to patients on critical matters, including surgery, cannot be equated to shared-decision making since it is a matter of life and death. The main reason why Fademn and Beauchamp are against the idea of utilizing shared decision-making between patients and surgeons is that it needs to be solely obtained from a patient (Vaughn, 2010, 197). Shared decision making is only applicable in a sense 1, where the surgeon and patients share information collectively regarding a specific surgery (Vaughn, 2010, 211). Since sense 2 is concerned about signing surgery papers, surgeons should not be involved in any case to avoid instances of manipulation and coercion.
Legal documentation of informed consent is yet another aspect to be considered before conducting surgery. Faden and Beauchamp seem not to be pleased with legal documentation provisions since most individuals do not understand the nursing procedures (Vaughn, 2010, 216). According to legal documentation on informed consent, a person of majority age with a sound mind has the capacity to decide what should be done on their bodies. This rule may not always be applicable since not all patients understand clearly medications and clinical procedures (Vaughn, 2010, 217). However, it is worth noting that legal documentation does not specify the depth of information that needs to be provided to patients as far as informed consent is concerned.
Among the barriers associated with shared decision making is dealing with overworked physicians. According to Vaughn (2010, 218), a considerable number of physicians are overworked, becoming a challenge in providing informed decisions, especially when exhausted. The author further suggests that patients may be provided with insufficient training regarding the management of specific healthcare conditions. Systems incapable of containing a shared decision process is also a barrier to achieving shared decision-making due to poor tracking of patients’ clinical records. The solution to the restrictions mentioned earlier is training patients consistently in addition to working towards honoring a patient’s autonomy (Vaughn, 2010, 219).
Question four
A clinical trial is defined as subjecting a specific population to a newly invented medication to ascertain its level of effectiveness. According to the Belmont Report, most of the developed drugs have a series of side effects that need to be addressed before trying them on the identified population (Vaughn, 2010, 218). The researcher’s argument about testing the AIDS drug on poor African communities is not in line with Belmont reports since it’s just a mere imagination. According to Vaughn (2010, 220), the medical trial is among the integral aspects considered before the approval of new medicines. As such, they need to be conducted with respect to the laid down regulations.
Respecting the proposition autonomy is yet another aspect against the above scenario of testing AIDS medication on poor African communities (Vaughn, 2010, 219). Although testing a drug requires the target population to volunteer, the researchers should ensure that the drug meets the threshold of autonomy. Autonomy is concerned about emphasizing more on ethical considerations in nursing practices to attain the patient’s interest. Based on the proposition of the scenario, the researcher knows well that AIDS medication has not yet reached the level of being tested on human beings since it is a mere imagination. Vaughn (2010, 220) opine that nurses should act diligently to ensure that they do not harm patients, which is the opposite of what the AIDS researcher intends to do.
When it comes to selecting the target population, the researcher should not focus on marginalized communities in a view to enjoy lessened regulations. The scenario provided above suggests that the researcher could not test the AIDS medication in the U.S due to legal based restrictions hence creating the mindset of trying it on poor African communities. Importantly, the opinion of using African based marginalized communities is not in line with ethical principles since the human body need to be treasured (Vaughn, 2010, 220). Besides, every human being is equal before God; thus, the researcher’s decision can be equated to a form of discrimination.
Question 5 (300 words)
According to Noonan, persons go overboard when driven by a view that personhood begins at the state of fetal experience, viability, or social visibility. Noonan provides a perfect example of personhood onset by suggesting that it begins right after fertilization. Notably, after fertilization, a person receives a genetic code in addition to receiving the right to live. Vaughn (2010, 348) ague that Noonan’s example regarding personhood is an exception since a genetic code contributes hugely in determining a human being’s personality. Noonan further enlightens that the genetic information formed after fertilization is the sole determinant of human being’s wisdom. Besides, it through having a genetic code that human beings evolve through various stages of life from conception through teenage to adulthood. Any abortion attempts after human fertilization are against human morals, and they can adversely impact the formation of personhood (Vaughn, 2010, 350). Since human life begins immediately after fertilization, abortion should be totally discouraged in all stages of embryos formation.
I agree with Noonan that personhood begins right after fertilization since the human ovary starts to divide within 24 hours of conception. Previous research suggests that embryo development begins at the fallopian tube, which occurs for up to three days after fertilization. The study further enlightens that there are a series of changes taking place on the fertilized human eggs, which are the basis for attaining personhood. The provision of Noonan is supported by (Vaughn 2010, 349), who suggests that multiplication of genetic code during early stages is vital since it enhances the formation of body parts. Importantly, normally born babies have all body parts during birth, bringing a suggestion that the development in the womb is the most vital. To this end, it is evident that Noonan’s propositions are worth to be considered since personhood cannot be attainment devoid of the healthy development of an embryo. Importantly, abortion instances should be discouraged in all levels of fetus development.
References
Vaughn, L. (2010). Bioethics: Principles, issues, and cases. 3rd ed, Oxford University.