Biomedical Ethics: Reflective Essay, December 2017
In this essay, I will discuss why I have chosen to become a physician assistant, the aspects of clinical practice most important to me, and how the principles of truthfulness and autonomy play the strongest role in my ethical decision-making while in practice.
My desire to become a PA mainly stems from shadowing an orthopedic surgery for a unilateral knee replacement. There, I saw a female PA attempt to stop a technician who was falling asleep from placing a piece of bone into the wrong container. She was too late and he contaminated the container but from that point, I kept observing the PA’s behavior and realized that not only did she pay close attention to detail for the patient, she also looked after her team members. Even though she was the only female member on the team, she made her presence known. Since then, my experiences have only solidified my desire to become the glue that looks after my patients, the glue that supports the members of my team, and the glue that watches over everyone’s well being.
When I become a licensed and certified PA, establishing a genuine relationship with my patients through increasing trust is most important to me as a provider. I have seen providers who spend a few minutes with their patients after hours of waiting. This is not an effective way of providing quality care since providers are not attempting to know patients, patients feel like they are not being cared for, and this amount of time does not provide patients with enough information to make sound decisions. As a provider, I want my patients to feel cared for, rather than being another patient with another complaint. Additionally, I will listen to patients prior to making any decisions regarding their care. I plan to be truthful to patients, increasing their trust to ultimately increase patient adherence towards a treatment. With enough time to provide patients with adequate information, this will hopefully increase autonomy and guide them in making a decision that is best suited for them.
The principles of truthfulness and autonomy will play the strongest roles in my ethical decision-making when I am a practicing PA. Truthfulness involves a two directional process between a provider and a patient with the goal of constructing, rather than discovering what is truth (Surbone, 2006, p. 944). The purpose is to increase patient participation in their decision-making process by increasing patient autonomy. While disclosing the truth, close attention must be paid to sufficiency and intent. Sufficiency involves sharing all relevant information and ensuring patient comprehension and appreciation in the context of their lives (Kirk, 2017, slides 12-14). Autonomy involves self-determination and the ability to make independent decisions as a free action after effective deliberation (Yeo, M, et al., 2010, p. 93-94). Autonomy as free action allows patients to make decisions by themselves without coercion and effective deliberation allows the patient to be empowered and equipped with adequate and relevant information to make a decision.
Being truthful is an essential component of building a sincere relationship with patients. When discussing information about a patient’s diagnosis, prognosis, and treatment, it is important to give pertinent information and present all available options regardless of any biases or barriers such as the type of insurance or other financial limitations. By providing such information, this allows for an increase in autonomy, as the patient is now equipped with the material needed to make a logical decision as a free action. If providers withhold any information, this is regarded as not being truthful and is a form of decreasing autonomy since there is a lack of effective deliberation. Autonomy may be compromised due to the lack of information and could lead to false assumptions as made by the patient. This may also harm the provider-patient relationship since this would reduce trust. In addition to providing the information necessary, patients need to understand and appreciate how their decision will affect them in daily life. It is not effective if patients do not understand the information given since that does not contribute to their decision-making capacity. In the case that a family member asks me to not disclose something to the patient, though I understand the intent behind that disclosure, I would find an alternative method of letting the patient know since patients have the right to such information, thus honoring the intent aspect of truthfulness.
In this essay, I discussed the story behind my desire to become a PA and why establishing a sincere relationship by being truthful to ultimately increase patient autonomy is most important in my ethical decision-making.
References:
- Kirk, T. (2017). Truthfulness in health care relationships. Slides 1-15.
- Sulmasy, DP. (2013). The varieties of human dignity: A logical and conceptual analysis. Medicine, Healthcare and Philosophy, 16(4), 937-44.
- Yeo, M et al. (2010). Autonomy[selections]. In M Yeo et al. (eds.). Concepts and Cases in NursingEthics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.
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