This case study presents an issue of the paternalism of the health-care professionals and family of the patient restricting the patient's autonomy. I think the approach taken by the medical professionals in this situation was morally reprehensible for a few different reasons. First, I believe the doctor does not have the right to override a competent patient's wishes based on the patient's family's opinions or his own. Ronald X was perfectly aware and understanding of the risks he faces living at home alone with his condition and should keep his right for autonomy concerning his living situation. Also, I found the last sentence especially worrisome because when Ronald still disagreed with his family and the physician, they sedated him so that he would comply; I thought this was a rather extreme method which was unjustified and further contributed to the stripping of his autonomy by external constraints. I feel the doctor only carries the right to compel a patient to live in a nursing home if that patient’s health is in immediate danger from living at home, which Ronald’s was not. Personally if I found myself in that situation, I would urge Ronald to consider a nursing home as an option for his own safety or advise him to talk to his children about other options such as one of them coming to live with him or hiring an at-home nurse so he can maintain some of his independence living in his own home while also being safe.
I agree with your position of the doctors being wrong in their actions. If a doctor were to tell me that I could not live alone for any reason I would argue that it is my life to live as I please, as long as it didn't interfere with others lives. By refusing Ronald's request and then further humiliating him by sedating him into compliance the doctors are showing a blatant disregard for his autonomy by subjugating him to what they wanted.
ReplyDeleteI agree that the patient's opinion when competent should be the only one to matter, his family's and the physician's opinion should not affect the decision. It is a case where informed consent was abused solely to get what they may have thought was best, but it was not the patient's interest.
ReplyDeleteMy Grandma lives alone at her house, although it is pretty safe for her she does need outside assistance. It creates problems at times since she is not very willing to allow outside people into her house. The kids ahve to help out with a lot, but people value their autonomy and it shouldn't be taken from them.
While I definitely disagree with the doctors choice to sedate Ronald, as the definition of what makes a patient incompetent to make a decision about their own health shifts continuously in our changing society, I worry where the line will be drawn and if one day old and and being senile will be considered conditions that make someone incompetent. I feel it's very important that health industry interested persons educate themselves on medical ethics, if only to be informed. Careful consideration should be taken when considering what conditions make someone competent, or we may end up one day deciding that stubborn-ness causes incompetence. I realize this may be taking it to the extreme, but the gravity of the situation must be taken seriously.
ReplyDeleteI definitely agree that a completely competent person's decisions should always override the physician's or their family's, but as Ali said, it's very hard to define what competent is. Whose judgment of competency do we use? The family or the physician's, or someone else's? Or even the patient themselves? It does get very complex when looking at the elderly, because it is hard to say when a person becomes incompetent in their old age. I can't believe, however, that the physician in this case sedated the patient in order to have him comply with what he wanted. This is an extreme case of a physician overstepping their boundaries.
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ReplyDeleteDanielle, if you read the case study from the book, it states that Ronald was very aware of his condition and what happens during his episodes of confusion and wandering. I believe this is the sign of a competent person. Personally, I would be more worried about the patient not being competent if they refused that they were in any danger with their condition, but it seems to me in this case that Ronald knew that he was in danger living alone but valued his independence enough to overrule that. This is the reason there are hospital psychologists that are trained to evaluate and recognize when a person should or shouldn't be allowed to be held accountable for their own decisions regarding their health.
Rachel, I think I would have to agree with you on the Ronald X case study. I think that when someone is fully aware of the consequences and risks of an option then ultimately it is their personal decision and Doctors, nurses, and family need to respect that decision even if it is not the best for the others involved. I think the problem with these types of cases like many cases is that if something were to happen, although it was the patients decision, it would or could come back to the parties involved. It ends up being a liability thing where everyone is ultimately looking out for themselves in the end.
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