CHWS opens conversation about patient autonomy

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B Angela Cookston

On April 5, the Bioethics Club hosted a Q&A session regarding patient autonomy with Colleen Carette, Physician’s Assistant at the Center of Health and Wellness Services. Patient’s rights and gray areas in bioethics were discussed in an educational conversation in Thompson Hall.

“Patient Autonomy is vital as the individual has the right to make decisions about their health care,” said Carette, “the mind and body in question belongs to the individual and they have the right to decide. The ‘gray’ area comes into play in regards to a child, the mentally ill, the elderly, [or] when the rights of the individual infringe upon the public welfare or public health needs.”

In the state of Washington, a person under the age of 18 can only give medical consent for emergency medical services. For non-emergency medical services, parent or guardian consent is required unless the minor meets the Mature Minor Doctrine, evaluated by “age, intelligence, maturity, training, experience, economic independence or lack thereof, general conduct as an adult and freedom from the control of parents,” according to the University of Washington Center for Sexual Assualt and Traumatic Stress.

Other than being a minor, patient autonomy can also be circumvented by medical professionals if the patient’s choice will endanger themselves or others.

Another ethical concern that those in the medical field face is what to do when a patient goes against medical advice. Carette said that she deals with this by making sure the patient has all of “the facts.” “Be sure they understand the possible repercussions, perhaps have the patient sign a consent form … ask to speak with a loved one if patient agrees,” she said.

However, at the end of the day, patients have the right to choose. “If the patient insists upon not taking the provider’s advice then [that means] supporting them in their own choice.”

Some questions asked during the Q&A session included what a medical provider might do in the case of a patient wanting to circumnavigate their medication to use alternative medicine. Carette was adamant in her response that the informed patient always has the right to decide what to do with their mind and body.

She gave an example of a student coming into CHWS with a UTI and turning down the use of antibiotics and turning toward a naturalistic remedy, such as cranberry supplements. The most important thing, she said, was to inform the patient of the risks and consequences of their decision, like informing the patient above that UTIs can lead to kidney problems if improperly treated.

Confidentiality is also an ethical concern in medicine. “Confidentiality is important to maintain privacy, security and trust in personal and professional relationships,” Carette said. “Confidentiality is valued and expected in any situation where sensitive information is accessed or shared … In rare cases, a medical provider can break a confidentiality agreement with the permission of the patient, or when required by law.”

“Confidentiality — requested or demanded — hinges on four important characteristics of the particular medical situation: the magnitude of the harm in question, the likelihood of the harm occurring, the existence of a real or hypothetical third party, and the effectiveness of medical interventions regarding the medical condition,” Carette said.

Another right patients in the state of Washington are given is the right to die. The Death with Dignity Act “allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live,” according to the Washington State Department of Health website.

This controversial act is debated in bioethics due to its grave nature. It was discussed during the Q&A to highlight to what extent ethics and medicine must go to protect the patient as well as protecting their wishes.

“Ethics — by definition — tries to find a beneficial balance between the activities of the individual and its effects on a collective,” Carette said.

For more information on ethics in medical fields, the Bioethics Club on campus meets Wednesdays at 5:30 p.m. in Thompson 197.

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