Patients and Doctors

醫學二 黃崇瑋 B9802054

IntroductionNow

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 Patient1. Right to medical care of good quality2. Right to freedom of choice3. Right to self-determination4. Right to information5. Right to confidentiality6. Right to Health Education7. Right to dignity8. Right to religious assistance

• Patient Autonomy

• Right to self-determination

• The 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. IntroductionA. Patient autonomyB. Dax Cowart case → patients’ autonomy

sometimes is not paramount.

Thesis statementWhen patients’ autonomy meets the decision

of life and death, it should be restricted properly.

II. BodyA. The reason why patients refuse medical treatment1. religious factors2. be sickening of life3. afraid of pain 4. prediction of miserable future5. economical factors

B. Doctor’s judgments and duties1. Historical records2. Laws3. Professional knowledge and skills4. Physicians’ mutual cooperation

C. Explanation How do doctors negate the reasons patients give? 1. religious factors2. be sickening of life3. afraid of pain 4. economical factors5. prediction of miserable future

D. Patient’s right to self-determination is acceptable but still has some problems.

1. Informed consent2. Law

E. What is the core concept doctors and society based on to interfere with patient’s autonomy?1. Chinese culture2. 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 FactorsCatholicism

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 consent1. 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!