[Dysphagia] A slippery slope

[eripley at yahoo.com (Irene Campbell-Taylor)]

Kathy Roeder <kroeder@beaumonthospitals.com> wrote:
I absolutely agree with you. Whose choice is it yours or theirs? 
Ownership of one's own body must supercede ownership by the state or
religious hierarchy.

*** The phrase that I find most alarming is that "....Health care professionals ..wary that respect for autonomy may sometimes cause avoidable harm." In the field of swallowing disorders, I have already encountered many individuals/ physicians/ facilities prepared to insert feeding tubes against the patient's expressed wishes, in situations in which it will not only be futile but will do "avoidable" harm. I left one hospital position over just this issue.

Irene.

 


KRoeder
Beaumont Hospital, Royal Oak, MI

>>> Irene Campbell-Taylor 01/05/05 02:04PM >>>
>From the Journal of Medical Ethics today:
My own opinion is that this is appalling:
Treating competent patients by force: the limits and lessons of
Israel's Patient's Rights Act Med Ethics 2005;31:29-34
M L Gross 

Correspondence to: 
Dr M L Gross 
Department of Political Science, University of Haifa, Israel;
mgross@poli..haifa.ac.il 


ABSTRACT 
Competent patients who refuse life saving medical treatment present a
dilemma for healthcare professionals. On one hand, respect for autonomy
and liberty demand that physicians respect a patient's decision to
refuse treatment. However, it is often apparent that such patients are
not fully competent. They may not adequately comprehend the benefits of
medical care, be overly anxious about pain, or discount the value of
their future state of health. Although most bioethicists are convinced
that partial autonomy or marginal competence of this kind demands the
same respect as full autonomy, Israeli legislators created a mechanism
to allow ethics committees to override patients' informed refusal and
treat them against their will. To do so, three conditions must be
satisfied: physicians must make every effort to ensure the patient
understands the risks of non-treatment, the treatment physicians propose
must offer a realistic chance of significant improvement, and there are
reasonable
expectations that the patient will consent retroactively. Although not
all of these conditions are equally cogent, they offer a way forward to
assure care for certain classes of competent patients without abandoning
the principle of autonomy altogether. These concerns reach past Israel
and should engage healthcare professionals wary that respect for
autonomy may sometimes cause avoidable harm. 





Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com 
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Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com