PATIENT AUTONOMY, WHILE NOT ABSOLUTE, TRUMPS BIOETHICS COMMITTEES

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SAINT JOHN PAUL II, AUTHOR OF THE ENCYCLICAL, EVANGELII VITAE (THE GOSPEL OF LIFE)

STEWARDS OF THE LIVING PERSON’S BODY

Joe Kral has given us the second installment of his article Stewards of the Body: End of Life Care in the Truth and Charity Forum http://www.truthandcharityforum.org/stewards-of-the-body-end-of-life-care/.   Like his first installment this one is based on false premises and misunderstanding of the teaching of Saint John Paul II in his Encyclical Letter Evangelium Vitae as was pointed out yesterday in the posts by Abyssum and Peter Amos on Abyssum.org.
Being the progressive that he is, Joe Kral seeks to extend the power of the medical profession (Administrators, Physicians and Bio-Ethics Committees) over the life of the patient.  At the heart of this issue lies the question of who has the power over human life.  The Catholic Church’s answer is: God.  But since God’s power is only visible to us in birth and death, the question of power in the time between birth and natural death devolves onto the individual.  It is the individual who has the power to determine what happens medically to oneself between birth and natural death.  Progressives seek to give that power more or less to others, and ultimately in our increasingly secular society, to the State.
The physician-patient relationship has undergone significant change during the past 100 years.  In the middle of the 20th Century the role of the physician was very paternalistic, by end of that Century the role came to be seen more and more a subject to the decisions of the patient.
Writing in the April 22, 1992 edition of the Journal of the American Medical Association, Ezekial J. Emanuel and Linda L. Emanuel gave us the definitive analysis of the physician-doctor relationship.  In their Abstract they wrote [emphasis in the text in bold type is by Abyssum]:

“The historical model for the physician-patient relationship involved patient dependence on the physician’s professional authority. Believing that the patient would benefit from the physician’s actions, a paternalistic model of care developed. Patient’s preferences were generally not elicited, and were over-ridden if they conflicted with the physician’s convictions about appropriate care.
During the second half of the twentieth century, the physician-patient relationship has evolved towards shared decision making. This model respects the patient as an autonomous agent with a right to hold views, to make choices, and to take actions based on personal values and beliefs. Patients are acknowledged to be entitled to weigh the benefits and risks of alternative treatments, including the alternative of no treatment, and to select the alternative that best promotes their own values.”

Toward the end of their article the Ezekiels indicate their opinion that while under “different circumstances different models may be appropriate….nevertheless, it is important to specify one model as the shared, paradigmatic reference”:

 

Thus it is widely agreed that in an emergency where delays in treatment to obtain informed consent might irreversibly harm the patient, the paternalistic model correctly guides physician-patient interactions….Conversely, for patients who have clear but conflicting values, the interpretive mode is probably justified….In other circumstances, where there is only a one-time physician-patient interaction without an ongoing relationship in which the patient’s values can be elucidated and compared with ideals, such as a walk-in center, the informative model may be justified.
Descriptively and prescriptively, we claim that the ideal physician relationship is the deliberative model.  We adduce six points to justify this claim.
First, the deliberative model more nearly embodies our ideal of autonomy. ….
Second, … The ideal physician is a caring physician who integrates the information and relevant values to make a recommendation and, through discussion attempts to persuade the patient to accept this recommendation as the intervention that best promotes his or her overall well-being.

Third, the deliberative model is not a disguised form of paternalism.  … the deliberative physician attempts to persuade the patient of the worthiness of certain values, not to impose those values paternalistically; the physicians’s aim is not to subject the patient to his or her will, but to persuade the patient of a course of action as desirable. ….
Fourth, physician values are relevant to patients and so inform their choice of a physician.  ….  And when disagreements between physicians and patients arise, there are discussions over which values are more important and should be realized in medical care.  Occasionally, when such disagreements undermine the physician-patient relationship and a caring attitude, a patient’s care is transferred to another physician.  ….

Fifth, … we expect physicians to promote certain values, such as ‘safer sex’ for patients with HIV or abstaining from or limiting alcohol use.  Similarly, patients are willing to adjust their values and actions to be more compatible with health-promoting values.
….
…the discourse regarding the physician-patient relationship has focused on to extremes:  autonomy and paternalism.  Many have attacked physicians as paternalistic, urging the empowerment of patients to control their own care.  This view, the informative model, has become dominant in bioethics and legal standards.  This model embodies a defective conception of patient autonomy, and it reduces the physician’s role to that of a technologist.  ….
Finally, it may be worth noting that the four models outlined herein are not limited to the medical realm; they may inform the public conception of other professional interactions as well.  We suggest that the ideal relationships between lawyer and client, religious mentor and laity, and educator and student are well described by by the deliberative model, at least in some of their essential aspects.”

What is basically at issue here is human liberty, autonomy.  The trend everywhere in our society is for more and more limitations to be placed on the free exercise of human liberty and autonomy.  We see it everywhere.  Students are told what they can do, what they can say, what they can wear, even the facial expression they can have.  Government imposes more and more limitations on free speech.  Everything now is scrutinized under the heading of discrimination, sexual, racial, ethic, etc.

In health care we must resist the efforts of those who promote the Third Path (passive euthanasia) in place of physician assisted suicide and direct euthanasia with their efforts to reduce patient autonomy and to give more power to the State, to hospital administrators, physicians and/or BioEthics Committees.
Sadly, it seems that Joe Kral, Joe Poejman, Jeffrey Patterson, Texas Catholic Confernce, et al by pushing for a new version of SB303 to be introduced in the 2015 Session of the Texas Legislature consciously or unconsciously advance the agenda of the Third Path.

 

About abyssum

I am a retired Roman Catholic Bishop, Bishop Emeritus of Corpus Christi, Texas
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