Ethical Principles In Medical Decision Making

In order for the interests of family members to be taken into account in medical decision making, I think that two principles have to be balanced. I think that patient autonomy and respect for persons have to be a part of every medical decision that an individual makes. The two principles are obviously going to come into conflict with one another in the decision making process, in which case autonomy should have more weight over the respect for persons principle.

I do not agree with John Hardwig's presumption of equality. Humans are just not wired to think that way, and the decision making process would become much too complicated as physicians became involved in the dynamics of families, attempting to morally and equally weigh the interests of patients and their families. Physicians have enough to consider as it is, as it is difficult enough determining which treatments and options will best benefit each patient's values and interests. Hardwig had the moral reasons for presumption of equality, but no solid explanations as to how the principle could be implemented. Patient autonomy would have to be sacrificed in order for the idea of presumption of equality to be honored.

I think that the interests of family members and those close to an individual should always be taken into consideration, but not necessarily given equal importance. Naturally family members can persuade, support, and participate in discussion and the joint decision making process, but when there is a conflict between autonomy and respect for the interests of family members, autonomy wins out.

The role of the physician, then, should be to respect patient autonomy by discussing possible treatments and providing all of the necessary information the patient needs to make an informed and autonomous decision as usual. In addition to this responsibility, doctors ought to also be trained to initiate discussion with the patient of their rights and responsibilities and encouraging patients to examine the moral implications and impact that their medical decisions will have on the family. If conflict between a patient's decision and family's interests arises, the physician should respect the patients choice and right to be autonomous.

#3) In Helga Wanglie's case, the physicians should have been allowed to withdraw from the case. Ackerman argues that the decision of whether or not treatment is beneficial to the patient is an ethical one, and has little to do with medical expertise. However, in order to make treatment decisions based on values, one must first have a general idea of what those values are. Mrs. Wanglie left no advanced directives to specify what she would have wanted, and the initial admission made by her husband revealed that the couple had never discussed what her desires would be should she ever become dependent on a respirator. In the absence of clear and convincing evidence of the patient's values, as well as a lack of information on which to base substituted judgment, the desires of an average reasonable person should be examined. As argued by Miles, a large majority of elderly patients prefer not to receive respirator support in circumstances of irreversible unconsciousness. Most would find that the burdens of this prolonged treatment outweigh the "possible, albeit highly unlikely" benefit of a return to consciousness.

This view is similar to that of the physicians, who found Mrs. Wanglie's treatment to be non-beneficial because the respirator could not heal her, prevent her from suffering, or enable her to experience the life it ultimately prolonged. The treatment not only failed to physically benefit Mrs. Wanglie, but detracts from the common good of the community as the insurance premiums members pay provide for Mrs. Wanglie's non-beneficial treatment. The physicians view is closer to the truth in this case. The medical care provided could no longer benefit Mrs. Wanglie, and without substantial proof that she would prefer to be kept alive under such circumstances, it is inappropriate to prolong treatment that does not achieve any sort of beneficial result beyond sustaining an irreversible coma.

#4) In the Cruzan case,