A Patient’s Right & a Physician’s Sworn Commitment: The Ultimate Balancing Act

A Patient’s Right & A Physician’s Sworn Commitment: The Ultimate Balancing Act

As healthcare providers, physicians are held to an undeniable standard. This should come as no surprise, seeing as life and death are in a precarious balance in the context of human life. As such, physicians are expected to perform their duties to the best of their ability while maintaining a constant commitment to the wellbeing of their patients. In total contrast to the relationship between a parent and their child, a physician cannot simply act on whatever decision they believe to be the best for their patient; unlike a child, the patient tends to be a mature individual capable of deciding how they want their care to proceed. In the context of healthcare, a balancing act between the ideas of beneficence and autonomy must be created in order to facilitate the most desirable health outcome. The issue can quickly evolve into a question of which ethical concept should take precedence over the other, and in what kind of situations this precedence should take place.

        Upon entry into the medical profession, physicians take part in reciting what is universally known as the Hippocratic oath. This pledge is a promise on the part of physicians that they will value the individuals in their care above all else. In the Journal of Medical Biography, Alan Emery summarizes the essential points of the oath as they are acknowledged today as those of beneficence, non-maleficence, and patient confidentiality. The first two concepts are much interrelated, as they both pertain directly to the physician’s treatment of patients; beneficence aims to work toward to whatever outcome is in the best interest of the patient while non-maleficence stresses the causation of no harm. This is not inherently an ethical dilemma, but it does become one when beneficent decisions of the physician come into conflict with autonomous decisions of the patient. Conceptually, patient autonomy is the right of patients to decide for themselves what is in their own best interest without the influence of their healthcare provider. According to Beauchamp and Childress, 1994 as cited by Stiggelbout and Otten, 2004 autonomy is the ability to act in an educated, intentional manner in order to come to a decision that has not been affected by any form of external influence. It is absolutely possible for a physician’s beneficence to be in alignment with the autonomy of the patient; this tends to be the case more often than not. However, when the two opposing ideals clash or don’t quite meet in the middle for various reasons, two methodologies quickly find their way to the forefront: the ideas of autonomy over beneficence, and beneficence taking priority over autonomy.

        On the subject of this discussion, it can often feel like a natural reaction to favor patient autonomy over physician beneficence. In the minds of many, why wouldn’t it be? The patient, if capable of making such important decisions, has the right to their body and what happens to it after all. There are a plethora of reasons for a patient to go against medical advice and make a decision that does not serve their best interest in its outcome. Whether the reason for this decision comes from a moral, emotional, or religious perspective, there is no doubt that it should be honored as long as the patient is fully aware of the implications. A prime example would be the case of Bob Marley, the musical reggae legend. During the height of his career, he was diagnosed with Acral Lentiginous Melanoma that first made itself known under one of his toenails. Porcia T. Bradford and her colleagues at the National Center for Biotechnology Information state that this melanoma subtype is sufficiently rare with a 67.5% survival rate if accurately detected in the early stages. In the case of Bob, medical intervention was available to him with a significant chance of eliminating his cancer. However, his strong devotion to the Rastafarian faith prevented him from accepting any treatment that involved cutting into his skin, so he refused treatment. The cancer consequently metastasized to his brain, liver, and lungs to cause his untimely death. The point in this example is that Bob made the choice to go against all medical advice in order to remain true to his faith, even though he was made aware that death would be the definite result. More so, his choice was respected. This specific example serves to illustrate just one of many scenarios where there is a case to be made for patient autonomy coming before the wishes of a well-meaning physician.