Ethics is an integral part of healthcare decisions. The following essay is guide to my clinical practice, which is backed by ethical principles. This guide is designed to start me off on the right foot in my first few years working as a PA.
The field of medicine is fascinating. People are unique each person’s body is a little different, and everyone has their own life circumstances and preferences. I chose to become a physician assistant because I enjoy working with people and because I find the human body to be interesting. Being a physician assistant will allow me to work with patients, and focus on the patient instead of focusing on paying up loans for medical school. It also comes with a nice work life balance. It is important for one to be healthy (physically and emotionally) before one can treat others. Being a physician assistant would allow me to do this in the best way possible.
Taking the time and having patience to explain diagnoses and treatment options, and counsel patients is important for all fields of medicine. This is especially important with geriatrics, who I see myself working with. Time allows the clinician the opportunity to be thorough with the patient. It also allows the clinician a chance to get to know their patient, physically, emotionally and socially. Informed consent is also important to me. For proper informed consent to be given time and patience must be given to the patient. The informed consent process was implemented to benefit patients. For a patient to give informed consent they need to understand the risks and benefits of all the treatment options relating to their diagnosis. Informed consent for treatment is required by law, consent from someone without decision making capacity is invalid (Appelbaum). Informed consent could only be given by a person with decision making capacity. For a person to have decision making capacity they need to be able to; clearly indicate a choice in treatment, they need to understand the diagnosis, treatment options and risks, benefits associated with all the options. They need to understand the consequences of the diagnosis and treatment. (AMA) They also have to be able to contemplate the various options. (Appelbaum) For informed consent to be done properly it is important for the clinician to spend time with the patient.
Autonomy and beneficence will play a major role in my clinical practice. Autonomy is the right for a patient to make their own health care decision to do what they want and not be forced to do what they don’t want (free action). Autonomy also includes autonomy of authenticity, moral reflection and effective deliberation. Authenticity is the concept that the patient’s choice matches up with who they are as a person, and their character. Moral reflection ask’s whether the decision matches up with their values. Autonomy of effective deliberation is one’s ability to weight the pros and cons to come up with a rational decision. (Yeo et al.) Autonomy of effective deliberation is only possible if one has decision making capacity. Beneficence involves increasing benefits. These benefits include both physical and psychosocial. Beneficence also includes non-maleficence which is not doing harm (or minimizing harm). Often the reason people say they go into medicine is to help people, as such beneficence is key.
Both autonomy and beneficence support and guide informed consent, taking time and having patience for the patient. To truly make an autonomous decision it is necessary to understand the diagnosis and treatment options fully. It is important to be patient and take time to explain, as this is the only way to ensure the patient understands fully. A patient who feels rushed is less likely to ask questions. Patients need to ask any questions they may have in order to come to a decision. Autonomy of effective deliberation is only possible if one has decision making capacity. Spending time with patients allows a clinicians to better understand if a person has decision making capacity. If a person doesn’t have decision making capacity, then maintaining autonomy can go against the principle of the beneficence and non-maleficence. Of course, these principles and ideas are important in all aspects of medicine, but it appeals to me because I intend to work with geriatrics. A significant number of geriatrics lose decision making capacity due to age. For example, a person with advanced Alzheimer’s or Parkinson’s Disease can lose cognitive abilities, thereby making them unable to make decisions on their own. (ncbi)
Spending time and having patience for patients are strongly related to beneficence. When a patient feels like a clinician spends time with them it benefits them psychologically. A patient can have a diagnosis which is difficult to hear, but just spending the time to listen to them and their concerns helps them feel better. Spending time with patient increases health outcomes and decreases complications. The increased time gives the patient and clinician time to address more issues. (alphaomegaalpha.org)
The goal of medicine is to treat patients and improve their lives. The methods chosen to treat patients and to benefit them is guided by ethical principles. Some of the best benefits a clinician can give a patient is time and informed consent. Giving a patient time, patience and informed consent is guided on the ethical principles of autonomy and beneficence. With these principles in mind I intend to do what is best for my patients.
References:
https://www.ama-assn.org/delivering-care/ethics/informed-consent (ama)
https://pdfs.semanticscholar.org/af99/18984238166ac6d4fb2b1f15b6498bf832bf.pdf (appelbaum)
Yeo, Michael et al. (2010). In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116. (Yeo)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579319/ (ncbi)
http://alphaomegaalpha.org/pharos/PDFs/2016-2-Byyny.pdf (alphaomegalpha)
