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Month: February 2017

When is it Okay to Tell a Patient ‘No’?

When is it Okay to Tell a Patient ‘No’?

Dr. Vercler’s presentation went over a lot of very interesting and deep topics on ethics. Should a doctor be allowed to say no? I think that in some circumstances and on a base-to-base case, a doctor/physician should be able to say ‘no’ to their patients. I’m sure some of you disagree with me but sometimes people want excessive surgeries or procedures, or want to make a decision that is not in their best interest. However, I do think that when telling a patient no, the doctor needs to explain why he/she is being denied certain care, and that this denial of care is being based on medical facts and what the doctor thinks would be best.

My father has a number of joint and bone issues due to being hit by a car before my birth, he continuously has to receive treatment via procedures and surgeries so that he can live his life to the fullest. He actually had another shoulder procedure at the University hospital last month. There is a procedure that can be done to take care of a vast majority of his neck and back pain, but that said this procedure has a higher risk rate and does not guarantee his ability to be pain free. As a result, physicians have told him that it is in his best interest to not have the procedure done, at least not until he is much older and is aware of the risks and possible benefits. In this case, my father’s best interest has been put first rather than choosing a producer than may ultimately hurt him more than help him. Some of you may think, ‘He’s crazy not to receive the care, he might be so much better off!’ but the reality is, he’s playing it much safer without having the procedure done. His denial of treatment is being substituted with smaller and safer procedures that can be done to help improve his quality of life.

My father was denied care but for the right reasons. The doctors, rather than lead him on with false hope, educated him on the procedure, the facts behind their decision, and an alternative that works just as well without all the risk. I think that although he has to have more than one procedure done, he does not have to worry about it all going wrong in one, risky, procedure.

In my book, sometimes you have a right to tell a patient ‘no’, and it works out for the better. The patient isn’t always going to make the right decision and it is the physicians job to lead them down a path of life and vitality, even if that means telling them ‘no’.

Choice in Healthcare

Choice in Healthcare

In healthcare, a surgeon is a lot like a physician. They should be doing what is best for their patients. No matter what the circumstances, the surgeon should look to the best interest of the patient before their own interests. Surgeons should not be able to refuse treatment that a patient wishes to be done. There is no excuse for giving up on a patient. I believe that the patient should have the best care possible and the surgeon should keep trying to help the patient no matter the chances of success of the procedure. A low success rate should not mean that the patient is given up on. Even if the procedure is extremely costly, the procedure should be done because a medical professional is there for the patient and not for their own personal gain.

Is It Okay to Say No?

Is It Okay to Say No?

A surgeon giving a medical procedure is like a physician prescribing medicine in some ways. When a patient goes to a physician feeling ill, the physician prescribes the best medicine for the problem. Similarly, surgeons will perform the surgery with the highest chance of helping the patient.

The difference between the two arises in cases when the chance of surviving with the treatment is very low, but even lower without treatment. When it comes to simply prescribing medicine, it should be given anyway. However, with a long, strenuous surgery the question is not that simple. The surgeon puts a lot of care and effort into a surgery, so to know that all that will probably be for nothing before the surgery even begins may make the surgeon object to performing it.

The reason for the objection is invalid, and they should have to do the surgery anyway as long as the patient requests it. It is a surgeon’s job to serve their patient; laziness, fatigue, or a low success rate are not good reasons to give up on the patient if they have not given up on themselves yet. Even if the surgery has the chance of causing death earlier, the patient’s request should be respected. The only case where the surgeon should have a right to ignore the patient’s request is if the surgery will only cause harm with no chance of benefits.

Who Makes The Choices?

Who Makes The Choices?

A lot of people pose the fact that health care professionals should follow the needs of their patients and their patients family and I agree with to an extent. In my opinion, I think health care professional should be able to refuse to give medical treatment to their patients when the outcome is not beneficial.  I believe this because all health professionals have been trained to know the extent to which their procedure can help or kill their patients; therefore, they know if the work the family wants done is worth it. On many occasions, I believe that many health care professionals will do whatever needs to be done to save their patients, but they also know when enough is enough. Although I feel like I would want everything possible to be done for the one I love, I would have to take into consideration that the procedure may not change the overall outcome and the doctors time could be used more efficiently on another patient. In certain situations, I think the family should be able to chose; however, the health care professional has to believe the outcome will result positively.

Decisions in Healthcare

Decisions in Healthcare

The most fundamental and basic goal of health care is to serve the community. When a doctor refuses to do as a patient wants or requires, they are no longer serving their community. If a doctor is to refuse giving a patient treatment that would either improve their life or save it, they are not only not serving the community, but they are in fact having a negative impact on the community.

In most practices, the physician is not running a monopoly, so there are generally other options of physician for a patient to go to. This does alleviate some of the negative impact that refusing treatment would have, but would also require more work and time on the patient’s part. This could also hurt the reputation of a physician.

One should also take into consideration the amount of education and training that the physician has over the patient in most cases. The physician is typically far more knowledgable than the patient and knows what treatments/procedures will work and which ones won’t. A patient may have looked up possible treatments on a source like WebMD and think they know what is best for them and view the doctor refusing to that specific treatment as unethical, when it is actually a matter of knowledge on the subject.In the case of surgeons, some patients want certain procedures done that they’ve heard of or they know people who got them. Sometimes these procedures are not applicable to them or too high-risk for their specific case and a surgeon is on the right side of ethics in refusing to perform a procedure they know is too high-risk.

Refusing to Give Treatment

Refusing to Give Treatment

Dr. Vercler offered amazing insight on ethics and also brought up the question of whether or not health care professionals should be able to refuse medical treatment for a patient. The first answer that came to mind was no. It is the duty of surgeons and other health care professionals to treat and care for patients. If the patient seeks treatment, they should get the treatment they want and need, right? But after more thinking, I came to the conclusion that there isn’t a simple rule whether or not health care professionals can refuse treatment, it truly depends on the situation and the best interest of the patients.

There are different reasons that health care professionals may want to refuse treatment. For example, health care providers may want to refuse treatment for fear of doing more harm or having a death of a patient on their shoulders, as well as other religious or ethical reasons. And for different situations, different actions may be taken in regards to refusing treatment. In the case of a small chance of survival from a surgical procedure, I think it may be appropriate for a surgeon to refuse treatment. However, I don’t think the situation should stop there. As a health care provider, they should still do their best to assure that the patient is well and satisfied. They could guide their patient in the right direction, give them other options or give them information of another provider who may be willing to help them—similar to what is done in end-of-life patient situations. On another note, some LGBTQ+ members are refused treatment, for many different reasons. In this situation, I don’t think it is right to refuse people treatment because it’s against one’s religion. However, in the case of transgendered kids, it may be important to refuse treatment to irreversible procedures at first to ensure the best decision was made for the patient. In the same way, it may be acceptable to refuse treatment to a patient who is not coherent or at an able state of mind to make rational decisions.

The patient’s wellness and autonomy is very important in the care-provider/patient relationship. And while treatment should be given when needed and requested by the patient, there are some situations where this can be over-ruled by the care-provider. When do you think it’d be appropriate to refuse care to patients?

The Freedom of Choice

The Freedom of Choice

Dr. Vercler provided an astounding knowledge of the historical aspect of ethics, but he also discussed modern day ethics. His question of whether a health care professional should be able to refuse to give a medical treatment or perform a procedure for a patient really got me thinking, because I can see both sides of the debate. Patients shoulder definitely be able to receive the procedures and treatments they seek, or not receive treatments they do not want, as long as they are fully aware of the risks associated with the treatment (or lack thereof) and are able to consider these risks before deciding to pursue treatment. But ultimately, I think it is completely acceptable for a health care provider to refuse to give a treatment or perform a procedure on a patient, but for certain reasons.

For example, a health care provider may not want to perform a procedure that would inevitably be detrimental to a patient’s health. The health care provider may not want to have the guilt or responsibility of harming the patient on their shoulders. Health care providers should also be able to refuse to perform procedures if the patient is not in a coherent and able state of mind to make rational decisions. Or a health professional may not think the patient is ready or old enough for certain irreversible procedures, like in so many cases of transgender children. Health care professionals are looked to for guidance and help, and it can definitely be frustrating to be refused treatment, but health care professionals have received years of training and schooling in order to use their best judgement, although not everyone will always agree with their decisions.

Dr. Vercler’s talk really made me think about my future as a health care provider. As a future nurse, I will be interacting with patients very frequently, and I will have to learn how to keep my personal views and opinions separate from my clinical judgements because at the end of the day, the ultimate goal is to give the patient as much information about risks and benefits of certain procedures to allow them to make autonomous decisions.

Medical Decisions

Medical Decisions

Dr. Vercler discussed the uniqueness of the surgeon role when he discussed the ways surgeons develop and invent new surgical techniques, the role of clinician vs. researcher, and the relationship between patient and surgeon. Surgeons are definitely a unique form of physician – they are more personally and deeply involved in each patient’s life and feel a greater level of responsibility for the patient’s outcome.

This relationship can present tension and create conflict in the patient – surgeon relationship when values differ. I think that the patient has the final say in whether they have an operation or procedure done or not. After all, it is their body and they will have to live with the outcome and aftermath of the procedure, not the surgeon. So, I think that as long as the patient fully understands the benefits and drawbacks of accepting and declining a procedure, then the surgeon should not deny them that. Of course, there are exceptions. If the patient is a minor who does not want the procedure done, but their parents do, then the patient’s wishes would not be met. Also, if the patient was not capable of making the decision for any reason, the surgeon would have the ability to decide whether or not do perform the procedure. But, this should be done with the patient’s best interest in mind, not the personal opinions and values of the surgeon.

Ethics in Healthcare

Ethics in Healthcare

The topic of whether a health professional should be able to refuse to provide medical treatments or procedures according to the patient’s wishes is very controversial. Most of the time, I would say no, a health professional should not withhold treatments or procedures from a patient. One of the major ethical rules of a health professional is to respect patient autonomy. This means that patients possess the right to make their own decisions about what will happen to their body. Surgeons also have a fiduciary responsibility, in which the patients place their trust in their hands. They have a responsibility to care for patients, in which if something can be done to cure them, then it must be done.

However, Dr. Vercler mentioned a situation in class that seems to blur the line of ethics. A 95-year-old man had a 100% chance of dying without surgery and with surgery only a 3% chance of survival. His family begs the surgeon to do the surgery because they believe that he is a fighter and would rather die in the operating room than not trying anything at all. This is a controversial scenario. It may seem unethical to refuse to go through with the surgery, but the patient is unable to state what he wants, and the family is only telling the surgeon what they think he would want. Either way, the patient has an extremely large probability of not surviving, especially considering his old age, so it may be best to not do the surgery and allow the patient to live comfortably during the end of his life. This also gives the family the opportunity to say proper goodbyes.

Overall, a major component to maintaining ethics in the health field is honoring patient autonomy. However, there are situations in which the ethical choice is not so clear, and it may be better for the health professional to make the decision for the patient.

Medical Decisions

Medical Decisions

I believe that a patient always has the right to receive any treatment they want done as long as the healthcare provider feels comfortable giving the care. A patient has the right to decide what they want to do with their body and how they want to proceed with their care. I feel that there are certain cases however, where a healthcare professional can choose to not treat a patient. This would be if a provider is uncomfortable performing the procedure and concerned about the potential well being of the patient. In this situation, the healthcare provider should refer the patient to someone who is able to provide the care they want. There is a great possibility that there will be a provider out there that is willing to treat the patient and is comfortable doing it. Another situation where the healthcare provider could refuse to give treatment is where the patient is not in the right state of mind or capable to make decisions on their health. The provider should be able to refuse as well if those advocating for that persons health are not around or uninformed. A doctor or other provider should not be able to refuse treatment in any other situations as it is their duty to provide their patients with care that the patient so desires.

I major aspect of healthcare is allowing the patient to have autonomy in their care. If doctors were able to refuse treatment to patients, personal autonomy would be lost. It is important that we keep a line between the relationship of healthcare providers and patients to ensure that the healthcare providers are not gaining too much power over their patients wishes. My question to you all is, what are other scenarios where a healthcare provider can refuse to treat a patient, and how should those situations be handled?