Patient Autonomy and a the physician's moral center
Patrick MPullicino, Physician, University of Kent, CanterburyP.Pullicino@kent.ac.uk
Submitted November 05, 2014
I read with interest the Daly et al. article on clinical and ethical judgment. [1] When making ethically-charged clinical decisions, the other variable between the extremes of autonomy and beneficence is the moral center of the physician. In my opinion, the treating physician should have a subjective line drawn, over which they will not cross, even if the patient and the majority-driven respect for autonomy, demand it.
Every physician has the right to exercise their own conscience. As Schor implies, part of a physician's role is to identify for the patient "what is or is not good and right for them" even if it is perceived as paternalistic. [2] In a modern environment where the patient's decision "has become almost sacrosanct," abandonment of this role will gradually, but surely, as Daly et al. said, "transform medical care into a medical service industry." [1]
The ascendance of autonomy as the highest arbiter of clinical decision allows the self-perceived good of the individual to gradually erode an ethical structure built by society over many years and to which doctors owe a major social debt. [3]
1. Daly B, Gokhale S, Ramos-Estebanez C. Clinical and ethical judgment: A profound dilemma. Neurology 2014;83:1369-1371.
2. Schor NF. Comment: Autonomy vs beneficence. Neurology 2014;83:1370.
3. Bernardin JC. Renewing the covenant with patients and society: Address to the American Medical Association House of Delegates, Washington, D.C. December 5th, 1995. CSA Bulletin 2009;58:52-59.
For disclosures, please contact the editorial office at journal@neurology.org.
I read with interest the Daly et al. article on clinical and ethical judgment. [1] When making ethically-charged clinical decisions, the other variable between the extremes of autonomy and beneficence is the moral center of the physician. In my opinion, the treating physician should have a subjective line drawn, over which they will not cross, even if the patient and the majority-driven respect for autonomy, demand it.
Every physician has the right to exercise their own conscience. As Schor implies, part of a physician's role is to identify for the patient "what is or is not good and right for them" even if it is perceived as paternalistic. [2] In a modern environment where the patient's decision "has become almost sacrosanct," abandonment of this role will gradually, but surely, as Daly et al. said, "transform medical care into a medical service industry." [1]
The ascendance of autonomy as the highest arbiter of clinical decision allows the self-perceived good of the individual to gradually erode an ethical structure built by society over many years and to which doctors owe a major social debt. [3]
1. Daly B, Gokhale S, Ramos-Estebanez C. Clinical and ethical judgment: A profound dilemma. Neurology 2014;83:1369-1371.
2. Schor NF. Comment: Autonomy vs beneficence. Neurology 2014;83:1370.
3. Bernardin JC. Renewing the covenant with patients and society: Address to the American Medical Association House of Delegates, Washington, D.C. December 5th, 1995. CSA Bulletin 2009;58:52-59.
For disclosures, please contact the editorial office at journal@neurology.org.