Interrelations of a doctor and a patient are multifaceted. They involve complex psychological and moral and ethical problems which a doctor should face daily. The right of a patient for information is one of the main rights in the sphere of provision of healthcare services. Being a fundamental human right, the right to information is guaranteed by the majority of countries in the world and protected by the rule of law. Ethical issues of “a doctor – a patient” relations in the case study will be discussed in this paper.
The patient has the right to receive detailed and accurate information about his/her health, give informed consent to the offered treatment, or refuse to accept it. In the discussed case study, a 35-year-old woman with a chronic disease made an informed decision to refuse transfusion as it is prohibited by her religious beliefs. However, being familiar with medical ethics, her attending physician should speak to the patient in private, away from her family, and offer her the option of a secret transfusion. Due to the fact that the patient is older than 15, able to control her senses, not an invalid or a drug abuser, she has the right to decide for herself on the possible treatment options and methods.
Moreover, the main doctor’s oath involves the principle of non-maleficence and patient’s confidentiality. Sritharan et al. (2001) indicates the medical oath based on the Hyppocratic Oath:
I shall never intentionally do or administer anything to the overall harm of my patients. … I will assist my patients to make informed decision that coincide with their own values and beliefs and will uphold patient confidentiality. (p. 1441)
Therefore, it is ethical to discuss the possible treatment variants with the patient without the presence of her family. The doctor should try to convince the patient of the necessity of the offered treatment in private. Nevertheless, the final decision should be taken by the patient. Patient’s refusal of medical treatment means termination of cooperation with the chosen medical establishment and the attending physician. In this case, neither medical institution nor the doctor bears responsibility for the life and health of the patient. If the patient decides to sign a refusal of consent to medical intervention, detailed information on the consequences of the decision, including the possibility of lethal outcome, should be provided to the patient by the attending physician.
The attending physician should meet with the patient in private and try to convince her to change her decision about transfusion. During the conversation with the patient, the doctor should establish relationships based on trust. It can be done by means of expression of support, understanding, respect and compassion. Support should be expressed to the patient in the form of assistance. It is important for the patient to understand that the doctor will willingly help her. Moreover, understanding of the patient’s situation is another important factor helping to convince the patient in the necessity of the offered therapy. When the doctor shows understanding, the patient is confident that her concerns will be heard and considered by the doctor.
Respect for the patient and her religious beliefs is another key point significantly affecting the result of “a doctor – a patient” cooperation. It is an obligation of the doctor to be respectful to the patient’s values and beliefs. The doctor should show concern about the way of life of the patient, her family, worries, interests, etc. (King, 2012, p. 230). Compassion is essential for the establishment of the trustworthy atmosphere in the communication with the patient. Therefore, the attending physician should consider internal factors causing the chronic disease (World Health Organization [WHO], 2013, p. 21). Thus, compassion, support, respect and understanding form the basis of medical ethics and facilitate effective treatment process.
Apart from private communication with the patient, it is also necessary to conduct work with her family. Trying to persuade the patient’s family in the necessity of the offered therapy, it is better to use strong argumentation, such as the sequence of “strong - weaker - the strongest” statements (King, 2012, p. 231). Thus, it is necessary to start from the argument: “Transfusion should be done because it will help to protect the organism from the increasing impact of the chronic disease” (a strong argument). The next one can be: “Refusal of the offered therapy can worsen the state of the patient’s health” (a weaker argument). It can be followed by: “Refusal of the therapy can result in the lethal outcome; the patient can die” (the strongest argument). Moreover, in some situations, the image and status of the doctor plays an important role (WHO, 2013, p. 23). The doctor should show his competence and instill confidence in the patient’s family members. His/ Her arguments should be convincing, especially those emphasizing the vital importance of the offered therapy.
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However, some issues should not be raised while speaking to the patient’s family. Firstly, the doctor should not criticize either the patient or her family for the late visit to the hospital or for beliefs prompting refusal of the offered therapy. Secondly, neither the patient nor her family should be humiliated or discriminated. They should be treated as equal participants of the treatment process and their opinions should be taken into consideration (WHO, 2013, p. 25). Moreover, the doctor should not insist on a private conversation in the presence of the patient’s family.
Clinical practice shows that problems arising during provision of healthcare to children or wards of the state have not only medical but also ethical character. They are present at all levels of the “a doctor - parents - a child” system. It is impossible to guarantee safety of children without a clear idea of ethical features of health protection. The following ethical and legal problems may arise while rendering healthcare services to children or wards of the state, there are. The paternalistic principle presupposes doctor’s responsibility for the treatment and outcome of the chosen therapy. According to this principle, the doctor is obliged to act for the sake of a child, thus defining what is good or bad for the patient. Parents’ refusal of diagnostics or treatment of a child due to their religious or ethical beliefs caused or lack of information or education comprise another ethical problem (Adolf, 2013, p. 180). The negative impact of incompetent advisers, including relatives, parents of other children, and inaccurate medical data can also lead to medical ethics issues (White, 2012, p. 188). All these ethical problems may arise in the interaction of a child, his/ her parents or representatives of the wards of state with the doctor. Thus, the doctor adopts a paternalistic approach to the patient, wishing to help a child, while his/ her parents may refuse treatment, basing their decision on inaccurate medical data and their religious way of life.
The attending physician of a child should try to convince the parents or the representatives of the ward of state of the necessity of treatment, emphasizing the vital importance of the proposed method of treatment. First of all, the doctor should create a trustworthy atmosphere and win the favor of the child’s parents. Secondly, he/ she should possess remarkable communication skills to convince the parents of the necessity of transfusion. The doctor should state that they can lose their child if he/ she does not undergo the necessary treatment. Moreover, knowing the importance of religion for the child’s parents, the attending physician should show respect to religion and focus on similar stories of treatment of children. Thus, the attending physician should speak to the child’s parents, showing respect for their religious beliefs and, at the same time, repeating that in case the offered treatment is not administered, they will lose their child. He/ She should argue that from the point of view of any religion, it is evil not to treat a child, allowing him/ her to die. Instead, the idea about the importance of transfusion and the possibility to continue living should be declared and promoted.
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However, if the parents of a child or the representatives of the ward of state still refuse the offered treatment, the attending physician and the medical organization have the right to address to the guardianship authorities or the court. In this case, the attending physician should continue treatment prescribed to a child based on the vital indications (Adolf, 2013, p. 182; White, 2012, p. 190). However, this question is not fully settled and remains a serious ethic and legal dilemma requiring tighter regulation. The influence and help of hospital and regional ethical committees having the legal status are necessary in this case.
The healthcare administrator must be aware of the legal proceedings caused by the provision of healthcare to the patient. Legislation on the need for informed consent of the patient to medical intervention guarantees realization of his/ her rights and, respectively, gives a chance to receive better and more effective treatment (Swendiman, 2012, p. 1). Responsibility for the consequences of refusal of medical interventions made by an adult patient without any psychological problems is imposed on the patient. The question of withholding consent to medical intervention by the parents of a sick child is rather complex and should be accurately regulated by law.
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The healthcare administrator should understand that the patient’s doctor bears the responsibility for negligent attitude to his/ her duties that may cause deterioration of the patient’s state of health as well as the failure to provide healthcare services. In case with a religious patient, the attending physician is responsible for the patient’s health. However, if any severe consequences or lethal outcome follow the refusal of the patient to undergo the offered therapeautical treatment, a doctor does not bear any legal responsibility.
Thus, since the moment of the appeal to a medical organization, a person has a right to medical information on his/ her diagnosis, treatment options, and possible consequences as well as the right to non-disclosure of this information. However, the impact of the patient’s family, relatives or close friends can pose obstacles for the effective treatment process. The analyzed case study outlined the importance of professional and personal qualities of a doctor while convincing the patient to agree to the offered treatment. Doctors and healthcare administrators should follow ethical rules and legal procedures while treating patients.
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