Patients and Doctors 醫學二 黃崇瑋 B

Introduction Now  Nowadays, the relationship between doctors and patients is gradually emphasized in the society.  The public pay more attention to the patient- centered medical care.  Many people begin to advocate the importance of patients’ autonomy.

Problem  When patient’s awareness rises, the relationship between patients and doctors is affected and the confliction may occur.  Introspection: May patients abuse the rights arbitrarily?

Is Patient’s Autonomy Paramount? My topic Discussion: How do you think? paramount: more important than anything else having the highest position or the greatest power

What is the definition of patients’ autonomy ?

World Medical Association Declaration of Lisbon on the Rights of the Patient 1. Right to medical care of good quality 2. Right to freedom of choice 3. Right to self-determination 4. Right to information 5. Right to confidentiality 6. Right to Health Education 7. Right to dignity 8. Right to religious assistance

Patient AutonomyRight to self-determinationThe right to refuse treatment The decision is concerned with death and life. Narrow down the topic

More specific  Assumption 1. If patients refuse treatment, they will die soon or in the near future. 2. If patients receive treatment, they can live long. 3. Patients are conscience, self-expressive and independent of machine for living.

Outline I. Introduction A. Patient autonomy B. Dax Cowart case → patients’ autonomy sometimes is not paramount.  Thesis statement When patients’ autonomy meets the decision of life and death, it should be restricted properly.

II. Body A. The reason why patients refuse medical treatment 1. religious factors 2. be sickening of life 3. afraid of pain 4. prediction of miserable future 5. economical factors B. Doctor’s judgments and duties 1. Historical records 2. Laws 3. Professional knowledge and skills 4. Physicians’ mutual cooperation

C. Explanation How do doctors negate the reasons patients give? 1. religious factors 2. be sickening of life 3. afraid of pain 4. economical factors 5. prediction of miserable future D. Patient’s right to self-determination is acceptable but still has some problems. 1. Informed consent 2. Law

E. What is the core concept doctors and society based on to interfere with patient’s autonomy? 1. Chinese culture 2. Life is paramount. 3. A patient is not the only person in the world but has interaction with society. 4. Doctors should focus on goodness of treatment and give hope to the patient. III. Conclusion

A. The reasons of patients refusing medical treatment 1.Religious Factors Catholicism Blood transfusion is not acceptable for certain Catholic communion. Sect: Jehovah Witnesses

2. Patients are sickening of life. Patients attempted to suicide but they failed. incomplete suicide

Therapeutic processes of some diseases and injuries are intolerably painful for people. For example: Burnt patients 3. Afraid of Pain

4. Prediction of Miserable Future Patient lose will to live due to serious injuries. Dax Cowart case disfigurement and disability

5. Economic Factors Some surgical operations cost a lot of money and patients cannot afford the expense. They do not want their family to be encumbered with debts.

B. Doctors’ Judgment And Duties 1.Historical records Hippocratic Oath : I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. The Declaration of Geneva : I will maintain the utmost respect for human life.

2. Law Medical care act §60 Hospitals and clinics shall provide emergency medical care and necessary precautions within the capability of personnel and facilities to emergency patients, and shall not delay without cause.

3. Professional Knowledge And Skills Doctors master in medicine and have professional medical knowledge. Patients are usually uneducated relative to doctors and do not understand medicine fields. Doctors should actively provide patients with professional information.

4. Physicians’ mutual cooperation  Psychiatrists should also participate in the treatment in order to correctly diagnose patients’ psychological state.  Mental disorder like depression, anxiety, will confuse patients’ thinking.

C. How do doctors negate the reasons patients give? 1. Patients are sickening of life.  90% patients suffer depression.  Depressed patients can not make reasonable decisions. Give first aid and psychotherapy  Mental Health Act

2. Afraid of Pain  The reason is too emotional.  The pain is inevitable in the course of treatment.  Doctors and patients’ family should pacify the patients as much as possible.  analgesic or aesthetics

3. Economical factors  Medical care act §60 The patient and his/her guardian is financially unable to afford the medical costs, the municipal or county (city) social administrative competent authority shall provide subsidies in accordance with the law.

4.Religious Factors  Right to Religious Assistance  Patients are allowed to comply with religious doctrine even though they may sacrifice their life.

 However, religious factors are sometimes negotiable.  Bible Leviticus Chapter 17 :13 You must not eat the blood of any creature, because the life of every creature is its blood; anyone who eats it must be cut off.  Bible didn’t say people can not accept blood transfusion.

5. Prediction of Miserable Future Posttraumatic stress disorder (PTSD)  loss of "physical integrity“  a response to the event that involved intense fear, horror or helplessness  persistent re-experiencing  fear of the future

D. Patient’s right to self-determination is acceptable but still has problems.  Informed consent 1. Patients are competent. 2. Patients should be informed well. 3. Patients should really understand the information. 4. Patients should be voluntary to make decision. Patients can refuse the treatment even though they will die.

 Problem It is difficult to evaluate a patient’s psychological state. state of wounded humanity  Solution It does not have correct answer. Attending doctors can consult psychiatrists, psychologists and patients’ family to assess the situation.

Law  Medical Care Act §63 Medical care institutions shall explain the reasons for surgical operation, success rate, possible side-effects and risks to the patient or his/her legal agent, and must obtain his/her consent and signature on letter of consent for surgery and anesthesia before commencing with surgical procedure. However, in case of emergency, the provisions above shall not apply.

Problem  The law doesn’t consider mental factors.  According to Mental Health Act, patients who are diagnosed with mental disorder can be treated forcibly.  Patients’ who suffer serious injuries or illness almost can be diagnosed with PTSD.

E. What is the core concept doctors and society based on to interfere with patient’s autonomy

1. Life is sacred and paramount.  The Universal Declaration of Human Rights: Everyone has the right to life.  Constitution of the Republic of China: The right of existence  absolute protection of life

2. Chinese culture  Confucius: Our bodies—to every hair and bit of skin— are received by us from our parents, and we must not presume to injure or wound them. This is the beginning of filial piety.

3. Humans are social creatures.  Everyone has interaction, feelings and relationship with his/her families, friends and anyone else.  The end of a human life affect not only himself /herself but also people surrounded him/her.

4. Doctors should give patients mentally positive support  Patients are in tough and adverse circumstances.  Doctors can focus on goodness of treatment more and give hope to patients. doctors’ basic moral conscience

Conclusion  Patients’ autonomy is not paramount in certain situation and is not allowed to exercise at will.  When patients’ right to self-determination collides with the right to life, prudential assessment is indispensable.  Patient’s autonomy is conditional and should be properly restricted by analyzing the reasons patients give.

Thanks for your attention & suggestions!