|
||||||||||||||
 |
||||||||||||||
|
Academy News: May 2005 The right to choose: who makes treatment decisions? The Ethics Committee provides these discussions as a way to open a dialogue on the various ethical issues that confront our specialty on a daily basis. These issues are often quite complex and do not have simple “right” or “wrong” solutions. The articles are meant as a way to highlight the various issues that are involved in these ethical dilemmas. They should not be viewed as the Ethics Committee or the AAAAI’s particular stance on an issue. One of Dr. DK’s patients comes to see him for worsening symptoms of asthma. After examining the patient, Dr. DK wants to make some changes to his medications, but the patient says he would rather try some vitamin preparations that he has read are good for asthma. Dr. DK has never heard of this vitamin preparation, and the patient is very resistant to the idea of trying new prescription medications for his therapy. What should Dr. DK do? Michael Fleming, MD, argues in a recent editorial on alternative therapies and cancer that the physician must “advocate for the patient’s right to choose any therapy….”(1) But does this mean the physician should allow the patient to use unproven or alternative therapies? The American Medical Association’s Code of Medical Ethics states that one of the principles of the patient-physician relationship is that “the patient has the right to make decisions regarding the health care that is recommended by his or her physician.”(2) But what happens when the physician does not recommend the treatment? Fleming argues that the physician should support the patient in trying alternative therapies–provided they do not have the potential for harm.(1) Nor would he support withholding known effective therapies just to try unproven alternatives. Further, he argues that the “use of alternative and complementary treatments has become so common that physicians must assume that all of their patients may be using one or more.” Physicians must learn about these therapies, and make sure that they “offer balanced information and help [the patients] evaluate their options.” In a reply to Fleming’s comments, Victor S. Sierpina, MD, discussed the ethical concepts involved dealing with alternative therapies.(1) The major ethical themes involved in this issue are autonomy, safety, efficacy, and hope. Autonomy is always a critical component of the patient-physician relationship, and Sierpina argues that “allowing” the patient to use alternative therapies “is inappropriate and reflects an authoritarian attitude….” The patient is supposed to be an informed partner in healthcare decisions, and not a passive recipient of the physician’s desires. The role of the physician is as “expert guide, a consultant.” The choice remains entirely the patient’s, informed by the physician. In addition to the physician doing no harm (the dictum, primum non nocere), the physician should also be required to “prevent patients from harming themselves.” It is not the patients’ role in the patient-physician relationship to be educated on the risks and benefits of traditional therapies, nor should it be their role to be so for alternative therapies. The physician has the responsibility to inform the patient of the benefits and risks of all types of available treatments. Thus, the physician should be able to educate the patient on the safety and efficacy of both traditional and non-traditional medications. As Sierpina states, “Presenting patients with the best evidence is sometimes the greatest service we can offer them. Arguing that they should not try an unproven therapy is unlikely to generate a good therapeutic relationship.” What about the issue of hope? While this issue is probably most relevant for life-threatening events, it does play a role in less dangerous situations. Sierpina feels that patients may choose alternative therapies as a way to “re-establish autonomy, control, and hope.” It is then important to delve into these issues to determine if there are deeper concerns that need to be discussed. And it is important to remember “one can disagree with a patient’s choices while compassionately engaging and supporting the person.” If we return to our vignette, what should Dr. DK do? It seems that the good doctor needs to first obtain information on the vitamin preparation. One of the problems with our current medical education system is that little attention is given to alternative therapies, although, to be fair, much more attention is being given now then in the past. This puts a burden on the physician to obtain this information from trusted and respectable sources. Once Dr. DK has learned about the risks and benefits of the vitamin preparation, he can then present this information to his patient. An alternative therapy that has no significant risks may be attractive to the patient, even if it has little efficacy. It is then the physician’s job to explain the importance of the more efficacious, but possibly greater risk, prescription medications. The final decision, however, remains with the patient. The physician must accept the decision and support the patient even if the practitioner disagrees with the final choice. References 1. AMA Medical News. Treatment choice is ultimately the patient’s. http://www.ama-assn.org/amednews/2004/10/04/prca1004.htm. Accessed on November 5, 2004. 2. Opinion 10.01. Fundamental elements of the patient-physician relationship. Code of Medical Ethics: Current Opinions with Annotations. American Medical Association. Council on Ethical and Judicial Affairs. 2002. p. 281.
|
|||||||||||||
|
© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
||||||||||||||
