Defending Patient Autonomy
UPDATE: Check out this commentary.
In medical school ethics seminars, we are inundated with the main ethical principles of the day — Justice, Beneficence, Nonmaleficence, and Autonomy. Special weight is given to autonomy – which basically states that a patient of sound mind should be the one to make their own choices about treatments. Long gone are the paternalistic days when physicians could simply order a treatment done; we must now offer a treatment, explain the risks and benefits thereof, and allow the patient to chose whether to accept it or not; i.e. obtain full, informed consent.
Oh, we may highly reccomend a treatment, and certainly influence patient decision making by the way we phrase the risks and benefits. But ultimately, at least in principle, we let the patient decide.
Apparently this is not the case in the US; witness the case of Abraham Cherrix, a 16 year old boy with Hodgkin’s Lymphoma who underwent chemotherapy last year. He had such a terrible experience that he refuses to undergo chemotherapy again under any circumstances. So when his cancer recurred, he opted to refuse chemotherapy and try some alternative therapies instead. His parents supported him in what sounds like a thought out decision.
He was taken to court and ordered to commence chemotherapy.
Well, the latest news (as of today) is that this was appealed and now there is an agreement that he need not take chemotherapy. So in the end, we are where he wanted to be — but why the expensive, time-consuming, and emotionally draining court proceedings?
If he was 18, this wouldn’t even be a case. Open and shut, patient autonomy. If chemotherapy for his condition had a terrible success rate, it wouldn’t be a case. (Apparently — and I am no cancer expert — it is felt that chemo has an 80% curative success rate.). Nevertheless, there was this whole paternalistic approach where the system believed it knew the right course for a coherent, intelligent young man better than he himself did. See here for more analysis.
Combine this case with a recent US law preventing underage women to cross state lines and get abortions without their parent’s consent, and episodes like this family’s experience with a camping trip, and you have a disturbing trend. It seems more and more that the govenrment – or society – or whoever – feels that they can scrutinize your decisions, you way of life, make judgmenets, and force change upon you.
And that, my friends, is a scary place to be.
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