A challenging situation I engaged in as a professional involved an old woman with type 2 diabetes refusing to take medicine because she was afraid of potential side effects. It was a chronic and irreversible problem at this point. The goals of the treatment were aimed at controlling blood sugar, reducing symptoms, and inducing remission. The proposed treatment would have been reconsidered if the patient showed adverse reactions to it (Jonsen et al., 2010). The proposed treatment options included managing blood sugar and using insulin. Other methods had a much lower probability of success. The patient would have benefitted much from receiving care and avoided harm by following the doctor’s prescriptions.
Patient’s Principles: The Principle of Respect for Autonomy
The patient had been informed of the benefits and risks, but seemed to not understand the information and was reluctant to give consent. The patient was mentally and legally competent but had preconceived notions about diabetic drugs. The patient preferred methods of treatment that did not involve insulin, such as lifestyle changes, and dietary changes. She expressed no prior preferences if incapacitated, and was capable of making decisions for herself (Jonsen et al., 2010). Her lack of cooperation was due to a lack of trust in the hospital system and the drug industry as a whole.
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
With the proposed treatment, the patient had a good chance to return to normal life, capable of managing oneself on a physical, mental, and social level. Without the treatment, at that stage, the patient could see a significant degradation in health and all associated aspects. Had the patient been incapacitated, it would have been judged for treating her, as she expressed no compunctions about the treatment on a religious or another basis; she simply thought the prescribed treatment would harm her more (Jonsen et al., 2010). No biases present could have affected the provider’s evaluation of the patient’s quality of life. The ethical dilemma that arose concerning improving it regarded the principles of beneficence and nonmaleficence versus respecting autonomy – the patient did not listen or accept the information about the treatment (Jonsen et al., 2010).
The assessment did not suggest the patient would have refused life-sustaining treatment but advocated for an alternative plan, which was not possible. Suicide as an informed decision on the part of the patient, aimed to reduce suffering, can be ethically-sound from the perspective of some frameworks. In the US, suicide is legal in 11 states; it did not pertain much to the chosen case.
Contextual Features: The Principles of Justice and Fairness
The interesting conflict, as perceived by the patient, was that Big Pharma wanted to enforce expensive drugs on her when other, cheaper, and better treatment options were available. Besides them, the clinicians, and the patient, there were no other members with an interest in clinical decisions (Jonsen et al., 2010). There were no limits imposed on patient confidentiality imposed by the legitimate interests of third parties in this scenario (Jonsen et al., 2010). The prevalent financial factor was that the woman thought the prescribed treatment was trying to force her to pay more than she thought she should. Considering the socio-economic standing of the patient, however, finances were not scarce for her; she could have afforded treatment. There were no religious issues influencing decision-making, but the legal issues largely revolved around informed consent. Clinical research on the diabetic treatment provided answers to all of the patient’s inquiries, but she refused to accept them, for a while. While there were no issues with public health and safety or conflicts of interest with the organization in question, the treatment could not have been enforced.
Resolution and Conclusions
Eventually, the patient was convinced to submit to conventional treatment, but only after the alternatives visibly failed. The Four Topics process utilized in this essay helped shape my decision-making by considering all aspects of the ethical application in decision-making. It appeared to be a solid and simple framework to apply in regular practice.
Jonsen A. R., Siegler M., & Winslade W. J. (Eds.). (2010). Clinical ethics: A practical approach to ethical decisions in clinical medicine (7th ed.). McGraw Hill.