The case arose from a patient, Jeff R, who visited a doctor (Dr. T) with a complaint of flu and requested for antibiotics. The symptoms he explained ascertained the doctor that he had the flu. Dr. T explains to the patient that antibiotics are irrelevant to use against the flu as well as other viral infections, unlike bacterial infections. She recommended fluids, rest, and at times over the counter drugs. Since Jeff R insists for an antibiotic, the doctor considers giving a prescription. Meanwhile, she figures out that the antibiotic would be harmless and psychologically helpful to Jeff R because he would feel that his condition is addressed. Dr. T also knows that bacteria will resist the available antibiotics if they are overused. The case clearly shows that the doctor informed Jeff R before prescribing antibiotics. So the latter would be accountable for any consequences related to overuse of the drugs.
Although the doctor gave a sufficiently clear result of the antibiotics, she still allowed the malpractice use by prescribing them to Jeff R. competent doctors have the obligation to refuse any prescription of irrelevant medication. In this case, Dr. T did what she could. She fully explained his understanding of the patient’s condition and even gave alternative remedies and risks associated with overuse. However, Jeff R’s condition seems so serious that he fears the uncertain outcomes of no medication at all, and it seems the drug is not problematic to him. The doctor faces some challenges. One is that she has to satisfy his patient by making prescriptions even when the condition is not a medical issue. Another one is to convince someone who does not seem to understand the consequences of drug abuse. She is also accountable for the consequences because it is his obligation to educate the patient as much as possible and find out how best to agree with him. Perhaps she is in a moral dilemma that competes with a non-moral psychological satisfaction of the patient.
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One side of the debate would be based on the principle of beneficence in bioethics (Beauchamp, Tom & James, 2001). That is, the doctor acted to promote the well-being of the patient by giving useless medication to make the patient feel that something has been done with his condition. The other side is about autonomy, which gives the patient the right to make informed decisions with his own free will. In this case, autonomy is an important value that defines medical quality in terms of results that are significant to Jeff R rather than the doctor. To some extent, his health progression would be a characteristic of his loss of autonomy. This is because he is insisting on something useless and risk-posing when he has been given safe alternatives to antibiotics.
Another concept is the principle of non-maleficence where the primary consideration is not to harm the patient rather than doing well to them. This is because some enthusiastic practitioners prescribe treatments that do good instead of adequately evaluating them to ensure no harm (Beauchamp, Tom & James, 2001). Practically, the patient was in a desperate situation where the outcome of no medication would be worse. Also, the doctor was in a situation that forced him to prescribe a risky treatment that would harm the patient. That is medically futile. The course of action gave a double-effect. That is, the risk of making bacteria resistant to antibiotics in the patient’s future, as well as making the patient psychologically comfortable by prescribing the wrong medications.
Here, autonomy and beneficence are conflicting. The doctor is supposed to balance the patient’s informed autonomy in the issue against the potential risks that would result from Jeff R’s medically unnecessary desires. For instance, a breach of Jeff R’s autonomy would decrease the confidence for healthcare services in the society and consequently, patients would not be willing to seek help medical help. This, in turn, would result in an inability to practice beneficence (Beauchamp, Tom & James, 2001).
I think it would be more valid to dishonor the patient’s interests. The doctor’s knowledge in science and medical practice validates the dishonor to take in to account the patient’s vulnerability which would result from prescribing antibiotics for the wrong purpose. Although patients have the right to elect personal medical decisions, the patient, in this case, should have delegated the decision-making duty to the doctor because she is well-knowledgeable about the condition and its safe remedies. It is not easy to provide the care that meets an individual’s desires when one faces demands to make efficient use of resources. Also, patients should get the best care possible, regardless of beliefs, sexuality, or age (Beauchamp, Tom & James, 2001).
Accounting for doctor-patient encounters, medical care is for the good of the patient, to get well from poor health conditions (Beauchamp, Tom & James, 2001). When this is not possible, comforting and caring, as part of how the patient lives with the condition is the healing purpose of medicine. Dr. T finds it wise to prescribe medication that would help, psychologically, to comfort the patient as he lives with the condition.
The situation is challenging though. The doctor has the right to reject the patient’s persuasions. In her view, aggressive prescriptions would be ineffective and harmful. It is an individual’s personal values that lead decisional importance of the fact. This is why patients are in situations that mere chances provided by medical considerations on what would succeed and what would not lead to automatic decisions. Something reasonable on probable grounds seems fundamentally distinct when perceived through religious, personal, as well as other lenses (Beauchamp, Tom & James, 2001).
Another subtle account is the notion that other things considered clinically appropriate might not be value-neutral but contains some hidden assumptions which are only comprehended by medical professions. For this reason, treatment of incompetent patients should be based on medical appropriateness. The medical profession’s values should be applied. It is better to apply a substitute judgment as well. In this case, the patient would have approached his next-of-kin to advice to be advised of the best course of action to take. It is almost hard to exactly comprehend why Jeff R refuses to take medical advice. After the long persuasion, it can be confidently concluded that he was in a serious condition that rendered him uncomfortable. In his opinion antibiotics would make him feel better. He rationally makes a decision to take them even after hearing about the risks associated with them (Beauchamp, Tom & James, 2001).
Doctors try to estimate what best options would be used on their patients. Most of what they do is to guess the best alternatives from the perspectives of physicians even when they contradict their patients’. They will only elicit patients’ expectations, ideas, and concerns when the approach is patient-centered and tactful. When good communication skills are coupled with truthfulness, information sharing and genuine objectives that benefit the patient, common goals could be achieved. It takes time. However, the time and effort employed are worth it in ensuring the best care to patients (Beauchamp, Tom & James, 2001).
In conclusion, it is a common experience in healthcare provision to encounter patients who reject medical advice. They should not be taken as uncooperative. Health care providers are obligated to inquire and understand their rationale for advice rejection. Some causes could be lack of the ability to make rational decisions as we as other genuine reasons for accepting the medical advice. These underlying factors could solve such conflicts if they are well-scrutinized. Trying to search for one ground would likely lead to an acceptable doctor-patient compromise (Beauchamp, Tom & James, 2001).
Reference
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford University Press, USA.
