When patients enter the emergency room, they expect to obtain help, support, and clarifications about what happens to their health. There are situations when patients are not ready to accept the diagnosis or recommendations offered by the medical staff. In this case, attention is paid to legal regulations and ethical issues to coordinate cooperation between doctors and patients. In this paper, a case of a female patient who refused surgery, even being aware of the death risk, will be analyzed. The main concern is that physicians used much pressure on the patient to convince her about the importance of surgery, and the surgeons performed the procedure without her consent. The analysis of ethical and legal aspects is based on the theory of utilitarianism to clarify if it is possible to justify the actions of the physicians.
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To understand if the physician’s action could be justified in any way, including the utilitarian one, it is necessary to identify all the issues in the case. The woman came to the hospital voluntarily, mentioning stomach pain as her chief complaint. According to utilitarianism, her decision was correct as it met the purpose of satisfying her physiological needs and improving health. The initial steps of care included routine assessment and communication. The findings proved that the woman had an abdominal aortic aneurysm, and its burst could lead to death within a short period of time. The only adequate treatment option is to do surgery and remove the aneurysm. However, after being informed about the chances of survival of about 50% and other postoperative complications and consequences, the patient refused surgery. She explained the inappropriateness and the negative impact of the scar on her job as a swimsuit model. In their turn, the physicians suspected her incorrect state of mind and repaired the aneurysm surgically without her consent. Although the outcomes of the operative procedure were positive, and the patient survived, a number of codes were broken, and additional concerns occurred.
From a medical point of view, the situation turns out to be clear and simple. A patient has a diagnosis, an abdominal aortic aneurysm, and one of the common treatments is to remove it with the help of surgical intervention. The supporters of utilitarianism approved the correctness of the decision to perform surgery. However, sometimes, aneurysms do not burst, and people continue living with it. Patients have to take medications, keep a healthy lifestyle, and manage regular check-ups. In this case, the physicians told about the importance of surgery, without mentioning all the details about alternative treatments. They used pressure, but it was not enough to convince the woman. According to Solomon (2017), misleading information is inappropriate in healthcare services. To start surgery, the consent should be signed by a patient or a legal representative. The medical staff could lie about the presence of the consent, which resulted in the patient’s discontent. Following the utilitarianism theory, a lie was the right thing as it helped to save a person’s life. Still, as it did not bring any pleasure to the patient, it could not be considered as the justification.
The patient was not able to learn that aneurysms could be treated with the help of endovascular repair that is explained as a less invasive intervention. It is possible to insert a graft in the leg and reach the aneurysm in the abdomen. Almost invisible scars are observed after such procedures, and there is a chance that the patient could agree with such a decision. However, if something went wrong during the procedure, the surgeons got enough reasons (intraoperative complications) to perform open abdominal surgery and save the patient’s life. The utilitarian point of view also supported the decision because the surgeons were satisfied with the outcomes, and the patient’s needs were met.
There are also several ethical aspects of health care that are based on respect for the patient’s autonomy, justice, and beneficence. The patient was fully aware that her rejection to accept a surgical procedure could lead to lethal outcomes. The physicians spent much time and pressure to give the necessary explanations, so they found her state of mind normal to analyze the information. There is a principle that every patient has the right to refuse treatment, and the obligation of doctors and nurses is to respect the choice of a patient. According to the theories and standards mentioned by Stein (2017), deception may be interpreted as an act of kindness to prevent harm. The medical staff could lie about the consent of the patient, believing that they helped her avoid death. However, at that moment, ethically, they had to respect her choice, even if it is at the expense of their obligation to save lives.
Ethical judgments are never simple, and healthcare workers have to understand that their opinions cannot influence the quality of care. It is an individual right of every person to live or die. The decision of the patient was her priority, and it was the thing that could make her happy as per the utilitarianism principles. The hospital did not have the right to anesthetize her and repair the aneurysm. To justify their actions, the medical staff should have one document – informed consent. Although she could die without treatment, it was her decision, and the medical staff did not break the law if they did nothing at that moment. There are special refusal treatment forms that patients sign in case they find it necessary to leave a hospital. Even if the representatives of consequentialism could use the fact that the patient survived and became healthy to justify the decision, the deontological and utilitarian perspectives prove that the decision was wrong because it did not follow the rules and did not make the patient happy.
One of the reasons for surgeons to neglect the patient’s freedoms and decision not to perform surgery is a questionable condition of her state of mind. Still, it seems that the staff had enough time to communicate with the patient, apply several methods to convince her and make other observations. It means that it was possible to take additional tests in order to find out legal and true approval of her mental problems. Unfortunately, before the anesthesia, the staff did not take tests or require additional assessments or counseling. There were no legally approved documents that the patient understood and accepted the terms of surgery. Following the theory of utilitarianism, the outcome of one conduct could be the basis for positive judgment only when a person is happy. It was a lucky chance that the patient survived, regarding the attention to detail that only 50% of survival was possible. If the patient died on the table, the hospital could be suited for intentional murder.
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In general, the decision either to perform surgery or not is the individual freedom of every patient who is conscious and robust. There are many situations when physicians and surgeons should take quick steps to protect the patient’s life. In this case, the female patient was clear in her intention to refuse surgery because of personal reasons. She informed the staff and did not sign any papers. The views of utilitarians and consequentialists are enough to prove that no ethical, medical, or legal justification could be offered to the hospital for justification.
Solomon, Robert C. 2017. “Is It Ever Right to Lie?” In Ethics Across the Professions: A Reader for Professional Ethics, 2nd ed., edited by Clancy Martin, Wayne Vaught, and Robert C. Solomon, 180-183. New York: Oxford University
Stein, Ronald H. 2017. “Lying and Deception for Counselors and Clients.” In Ethics Across the Professions: A Reader for Professional Ethics, 2nd ed., edited by Clancy Martin, Wayne Vaught, and Robert C. Solomon, 217-221. New York: Oxford University Press.