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The Ethics Of Capacity And Competency: Going Against A Patient’s Decision

2005 words - 9 pages

A homeless man entered the hospital with chronic gangrene, osteomyelitis, and diabetes. Doctors could tell that he had a psychiatric condition, but the patient refused to have interventions of any kind; he didn’t allow doctors to treat him with medication or submit to a psychiatric evaluation. He claimed to want simply to be fed, given his insulin, and given a bed. He was also difficult with the nurses, throwing urine at them and making them generally uncomfortable. Doctors tried to coax him into accepting intravenous antibiotics, but he refused. The choice: send him back to the street, a possible violation of the “First do no harm” oath, or seek a court order declaring the man ...view middle of the document...

The next moral value at stake is the safety of the patient. The Hippocratic oath, which is a historical document that laid the groundwork for how healthcare professionals practice medicine ethically, states to “benefit the patient and protect the patient from harm” (Veatch, 2012, p 47). By doing so physicians weigh the risks and benefits of the situation, choosing the option that yields the best outcome and avoid the most harm. Veatch describes the risk and benefit ratio in terms of beneficence and nonmaleficence, where beneficence is “the moral principle that actions or practices are right insofar as they produce good consequences” and nonmaleficence is the “moral principle that actions or practices are right insofar as they avoid producing bad consequences” (p 60). In this case the benefits of respecting the patients autonomy also has the outcome of doing harm by discharging the patient into an unsafe environment that can further contribute to the decline of his health. The second option of forcing the patient into the doctors care has the benefit of improving the patient’s health, however it also has the harm of going against the ethic of respects for persons. The dilemma the doctors now face between the two options is which one will benefit the patient more with the intent of avoiding harm.

In this particular case the patient presents to the doctors with a psychiatric condition. With this additional aspect, the two moral values stated above bring in further implications. The first is the principle of autonomy, which is a right that is respected as long as the individual is competent to make decisions. The aspect of being competent is defined as “the ability to understand, appreciate, and manipulate information and formal rational decisions” (Leo, 1999, p 132). If the patient is incompetent, the right of autonomy is no longer valid; however the ethics of respect for persons still holds that an individual who lacks autonomy should still be protected. In this sense beneficence and nonmaleficence also comes into play, because now the doctors need to re-evaluate and determine how to approach this situation, choosing the outcome that best benefits the patient with the additional possibility that the patient’s decision making capacity may not be intact.

The Options
As mentioned earlier the options of this case would be to either discharge the patient or find a way to place him under the doctor’s care. The doctor’s who are caring for this patient would have to respect his ability to decline any medical intervention as long as the patient is competent; if there is suspect that the patient lacks the ability to make autonomous decisions, then further action must be taken to place the incompetent patient under a surrogate who makes decisions for him.

The action of paternalism in a weak form can be defined as “actions taken for the benefit of an individual who is either known to be incompetent or who is suspected of...

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