Healthcare relationships: Should healthcare decisions be up to the patient?

[Intro + Jingle] Should you be free to ignore your doctor's medical advice? In this WiPhi video, we’ll explore the value of patient autonomy in their health care decisions. Think back to the last time that you visited a doctor. Why did you go? Most likely, you went because something was bothering you -you were feeling sick, or you fell and needed a doctor’s help. Or perhaps you were just going for your routine check-up to ensure your long-term health. In any case, you didn’t have to see a doctor. You could have chosen to sleep it off or try an old family cure or searched online for your symptoms and a potential treatment. Given these options, why did you choose to go to the doctor? Chances are that you went because you believe the doctor is the expert. Most of us want to look after our health as best we can. However, very few of us have the medical knowledge to do that, and we can really struggle to know what to do with the information even when we have it. Left to ourselves, it’s likely that we would be worse off. Yet, if you recall that last time you went to the doctor, you know that once your condition is diagnosed, it’s you- not the doctor - who makes the ultimate treatment decision. The doctor doesn’t just start treating you. They first talk you through the diagnosis, offer the treatment options and their advice, and answer your questions. Only if you agree do they then proceed. The treatment decision always rests with you, even if the doctor believes it’s a mistake. But wait - if the doctor knows what’s best for you, wouldn’t the treatment decision be better left to them, not you? Presumably, you’d only go against your doctor’s advice if you were being irrational. It would be understandable: medical procedures are often scary and risk calculations are often confusing. But isn’t that all the more reason to keep the decision in the hands of the expert? So maybe that would be better? Maybe doctors should always just make our healthcare decisions for us? Well, that would give your doctor a lot of power over your life. And with power comes the potential for abuse, with the doctor promoting their own interests and priorities over yours. When conducting experiments during World War II, for instance, Nazi doctors actually tortured and murdered the people in their care. More subtly, researchers conducting an experiment in Tuskegee, Alabama provided free medical care to hundreds of impoverished African American men. But though they knew that many of these patients had syphilis, the researchers never treated these patients for this condition -- - never even informed the men that they had it - which just led to further transmission and many deaths. Why did they do this? In order to study the effects of untreated syphilis. Wait, you say! These are extreme cases. Most doctors are well-intentioned and wouldn’t abuse their power like this. But there’s another problem that could involve even your friendly GP. Think about your health and well-being as on a set of scales. On one side is your physical health and on the other are the principles and values of the life you’re trying to live. To promote your overall well-being, the two sides need to be balanced - and this balance isn’t the same for everyone. After all, a hand injury may mean little to a lawyer, but it can be devastating to a concert pianist. Now, in modern liberal societies, we tend to believe that there is a plurality of values by which we live. We practice different religions, raise our children in different ways, vote for different political parties… And most of us believe that the ability to live according to our own values, reasons and interests – to live autonomously – is itself an important value that ought to be respected. And here's the problem. The doctor may know all about the medical side of the scale, but she’s no expert on the life you want to live. She will need to make some assumptions here, and she may well get it wrong. This suggests that you should be involved in a medical decision in some way. But it doesn’t explain why you should be the one making the final decision. Why couldn’t you just sit down and talk to the doctor about the values and interests at stake for you? Then, the fully informed doctor – but still the doctor – would make the final decision. Wouldn’t that be good enough? Not really. Suppose a Jehovah’s Witness is discussing treatment options for a hip injury with his doctor. One of the doctrines held by most Jehovah’s Witnesses is that it’s wrong to accept a blood transfusion, even to save a life. Now suppose the doctor thinks this value is wrong, simply ignoring the concern and deciding to do the surgery. If the patient ends up needing a blood transfusion, so be it. This doctor is failing to respect the patient’s autonomy. And if the patient wakes up to learn that he required a transfusion during surgery, he might become deeply distressed. He might even end up being ostracised from his community. Who is the doctor to decide that these risks are worth taking? In pluralistic societies respect for autonomy is prioritized, so the ultimate decision about your healthcare is yours - even if your doctor strongly disagrees about what’s best for you. This doesn’t mean that the doctor has no role. If you are to make a decision that is aligned with your values, you still need to know what your options are and what should be considered on the medical side of the scale. This understanding is gained through a clear, in-depth conversation with your doctor, after which you are hopefully well-positioned to make the final call: giving, or withholding, your -- now, informed -- consent. But if you are to balance the scales, making a decision that’s in your best interest as you see it, you need to trust that your doctor knows and respects your values - that the medical information she shares and advice she gives are offered with due consideration to your values, regardless of whether she shares them. So perhaps the more pressing question is: How much do you trust your doctor? What do you think? [Outro + Jingle]