Heroics and healing

✍ Scribed by Cynthia MacLeod

• Book ID: 104625061
• Publisher: Springer
• Year: 1990
• Tongue: English
• Weight: 323 KB
• Volume: 2
• Category: Article
• ISSN: 0956-2737
• DOI: 10.1007/bf00057832

✦ Synopsis

The ethical principles which guide hospital ethics committees (HEC) include autonomy and beneficence, but between them exists a charged tension. The traditions of medical care dictated the physician's posture of medical certainty and benevolence which, in turn, elicited the patient's unquestioning obeisance to the physician's directive.

Social, political, and economic changes have advanced the role of patient autonomy at a time of escalating technological approaches to disease and disability. The moral tone of medical beneficence and medical paternalism is upset by a call for increased patient inclusion in decisionmaking.

This paper will explore the necessary tension between beneficence and autonomy from the perspectives of several burn care specialists and the controversy that exists concerning the care of burn patients whose treatable injuries yield unprecedented survival. It is hoped that by viewing this issue through these patients' special situation we may examine current practices for other patients and their needs. The relevance to HECs will be discussed in the conclusion.

Flowing from the purpose and functions of HECs is a duty to model and promote communication and problem-solving skills for members of the hospital community. This is actualized through the functions of education and consultation, and it reaches to the bedside where caregiver and patient work to create a healing pathway. The communication between a physician and patient is advanced through a clear presentation of information and treatment options as well as the physician's sensitivity when listening to and addressing the patient's concerns and value statements.

In this process a tension between patient autonomy and medical beneficence may emerge.

Medical paternalism is antithetical to autonomy and is generally interpreted as the physician's presumption to make decisions in the best interests of his or her patients but without their consent. There are many gradations of paternalism which can subtly color the interaction between client and doctor. James Childress defines 'weak' paternalism as an intervention on behalf of a