Autonomy and Informed Consent

In a situation wherein a patient with the capability to formulate rational and coherent decisions refuses to undergo treatment despite the health service professionals desire to do so, the doctor should adhere to the patients wishes. As such, an appropriate ending for the case presented in the study involves the doctors adherence to Janes desire to end her treatment. The reasons for this will be specified in this discussion as it initially outlines the role and importance of informed consent in the health care profession.

The practice of personal autonomy involves the ability to rule ones self in conditions without external restraints. In order to practice personal autonomy, it is thereby necessary for an individual to possess both liberty and agency. In the field of medicine, the recognition of the importance of autonomy is evident in the enforcement of the principle of informed consent. The principle posits that a persons autonomy ought to be respected either (1) through the tacit acquisition of his autonomous authorization in a medical intervention orparticipation in research or (2) through the recognition and practice of an institutionally or legally effective authorizationdetermined by prevailing rules.  In both the personal and institutional contextualization of informed consent ((1) and (2) above), the elements of informed consent include (1) competence, (2) voluntariness, (3) disclosure of material information, recommendation of a plan, (5) understanding of (3) and (4), (6) decision in favor of a plan, (and) (7) authorization of the chosen plan (Beauchamp and Childress 80).

In the case study, Jane was described to be competent and hence capable of voluntarily deciding whether she will undergo the treatment for her burns. In addition, the case also specified the she understood and hence authorized the plan of action for the treatment. A problem however occurred because of the doctors refusal to end her treatment despite Janes explicit desire to end it due to her unwillingness to subject herself to the amount of pain involved in the process. According to the study, the reason for the doctors refusal lies in his belief that Jane will appreciate the physical toll of her treatment as she recovers. The case thereby presents an instance wherein a doctor refuses to recognize his patients autonomy. This situation is problematic as it presents an instance of (1) the failure to respect a patients autonomy, which translates to the failure to respect the patients right to be left alone and (2) the doctors failure to practice his professional obligation towards his patient, which translates, to his failure to respect his patients negative right. It is important to note that the second problem is contingent on the initial problem since respect for personal autonomy is considered as a professional obligation in health care. The doctors failure to uphold his professional obligation is evident as he forwards his preferences over that of the patient. It is important to note that the minimum requirements for the practice of autonomy are the ability to reflect critically upon ones first-order preferences and desires, and the ability either to identify with these or to change them in light of higher-order preferences and values.

Since Jane was able to provide cogent and rational explanations for her preference to die rather than experience extreme pain in the treatment, it follows that she is in possession of her autonomy. Although one may argue that the doctor has higher order preferences and values in his decision to continue the treatment, that being the preference of the maintenance of life, this does not change the fact that his refusal to adhere to Janes wishes is an instance of his abject decision to violate her autonomy.

Within this context, the doctor ought to end Janes treatment since continuing her treatment violates both the ethical and procedural rules in the patient and physician relationship. Janes refusal to continue her treatment may not be ethically overridden based on the principle of beneficence since Jane has been confirmed to be competent to understand and decide on her case as was mentioned in the study. It is important to note that the principle of beneficence may be applied in the situation if the doctor provides Jane with an alternative treatment that addresses her concerns regarding the extent of pain she experiences in the process. Given the variables presented in the case however, the doctor ought to end Janes treatment doing so would be in accordance to the principles of biomedical ethics.


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