Archives for posts with tag: bioethics

You can’t fully understand what someone else needs as a human being, and all the more so as a patient, without recognizing two things: their essential commonality with you – you are both human beings – and their uniqueness. Each person has particular wishes. Thus, only through a relationship based on trust, in which each party feels safe enough to divulge those wishes, and a relationship based on open communication, in which those wishes are actually stated, can ethical practice, medical or otherwise, be achieved.

The relationship, however, is reciprocal. Ethics is not reducible to communication, nor vice versa. Some have even suggested that relationship difficulties in the doctor-patient relationship are best dealt with through expanded use of the specialty bioethics consult service. I argue against this notion in a recent article, which you can read here. Communication is something which every provider should work towards achieving, and though bioethics has much to offer medicine, a specialty consult can do more harm than good to the patient-doctor relationship – especially one beset by difficulties.

I have read several articles in leading journals – most recently in the Annals of Internal Medicine about tailoring mammography recommendations to patient risk – which come to the same conclusion: no matter what physicians’ recommendations are, we must respect patient preferences. There are various difficulties with this:

1. Patients, in fact anyone, are often hard-pressed to state just what their preferences are. There are a number of reasons for this: the fact that information is often not adequately conveyed; the tyranny of choice from the overabundance of medical information; and, at bottom, the truth that some situations are not ones we are prepared to state preferences about. “Would you rather die in a nursing home or in a hospital?” is, for those not yet in such a situation, equivalent to asking, “Would you rather perish by Dalek or Vader?”

2. We don’t actually respect patients’ preferences, much of the time. We try to make them do things which they would not ordinarily do. Which leads us to…

3. Preferences change. Many change their desires and even their approach to life over time. When we “respect a preference,” whose preference, at what stage of life, are we respecting, and how much respect are we really supposed to show?

Here’s the video of my talk at the Berman Institute. The slides are located here.

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