There are four principles of ethics that are widely used in order to decide the morality and uprightness of any procedure done in the field of medicine. These principles include the right to autonomy, beneficence, non-maleficence, and justice. The case in question concerns a45-year old man requesting medical practitioners to amputate his right arm as he feels that it “ doesn’t belong to him”. This paper shall argue that amputation of the right arm should not be performed by doctors without knowledge and consent of the family. In lieu of this, they should suggest other means of treatment for the patient. Such a position, though may conflict with the principle of autonomy, is attributed to the principle of beneficence, which is the desire of the medical practitioner to do good to the patient. Also, he may be suffering from a harmless mental illness, which makes him unfit to decide for his own and, thus, must seek consent from the family.
Doctors think that he may be suffering from a type of body integrity identity disorder (BIID) wherein there is an eerie desire to eliminate parts of his body that are otherwise healthy. This circumstance may be sufficient evidence that the person is suffering from a mental illness which requires different treatment goals and processes. Mental illness presents conflicting aspects in the field of bioethics such as principles of autonomy becoming uncertain. Competency of the person in making decisions for himself is largely questioned, and thus informed consent may not be of significant value. Furthermore, the basis that the patient is suffering from the psychological disorder may be enough indication that the act of beneficence is regarded before respecting autonomy, despite the latter being said to be higher in consideration than the former (“ Principles of Medical Ethics”, 180).
Being that autonomy becomes uncertain to the patient, it may therefore be safe to transfer rights of informed consent to other people connected to the patient, who has a good chance of dealing with his condition after the treatment or operation is done. This provides reason to the act of informing family members and relatives of the decision that was made, in the belief that they may give sound advice to the patient or give their consent with finality. Such an act is also done in order to avoid the “ undesirable outcome of pure beneficence, [which] is paternalism” (“ Principles of Medical Ethics”, 180). The mere fact that the doctor will reject the request of the patient to amputate his arm can be a form of paternalism in itself. This is because he has “[performed] an intentional act on behalf of an individual against the person’s wishes” (Snow & Austin, 180), in order to do good than bring harm to the patient.
Still, some may think that this act committed by doctors may be a form of force in the latter’s part, especially when they are believed to usually gear to the practice of autonomy instead of paternalism and benevolence. Coercion of patients to do what health care professionals deemed to be the ‘ right’ decision for the patient may cause non-compliance of the same to further treatments initiated by medical practitioners, lessened opportunities to gain control over the illness, and inability to develop coping mechanisms and be educated about their illness (Snow & Austin, 181). Such is the case with community treated orders (CTOs), which are law mandated treatment options wherein patients undergo psychiatric treatment even in the outpatient setting, with or without prior consent (Snow & Austin, 178). There have been evidences backing up the lack of positive results of enforcing such treatments to patients and painting CTOs and like treatments as a “ coercive measure” (qtd. in Snow & Austin, 181).
While it is true that some aspect of coercion is needed especially in order to motivate a person not to amputate his arm, there were measures undertaken and previously mentioned to not lessen the gravity of such an accusation. These preventive measures largely involved the use of the surrounding community (i. e. the family members). Because the process would probably take a negative hit in the relationship of the health professional and the patient, the next best thing in order to assure compliance is to establish support group that will make the patient feel they are not alone. It is a widely known fact that with decreasing availability of mental health facilities, care of the mentally ill is being greatly entrusted to the community, thus more of family responsibility is urged. Furthermore, the harmless nature of the patient, except to himself allows family to narrow fear of any untoward incident happening and focus mainly on observing and taking care of the patient. Studies actually do show that while patient may feel “ reluctant acceptance” to the coercive measure, they are later on found out to perceive benefits with it after they have experienced the treatment regimen (Snow & Austin, 181).
As such, while there is the notion of complete neglect to autonomy in the decision of not amputating the patient’s right arm, there is also the other side of the coin which signifies great concern of the health care professional regarding the overall well-being and health of the patient. The risk there is to take in accounting for what should and should not be done is great and under the shoulders of any health care professional. It may to look into certain policies such as the United Nations Declaration of Human Rights in order to know what is legally and morally right. “ Article 3 addresses right to life, liberty and security Article 12 identifies ‘ No one shall be [under] arbitrary interference but Article 25 states ‘ Everyone has the right to a standard of living adequate for the health and well-being of himself” (Snow & Austin, 182).
Snow, N., and Austin, W. J. “ Community treatment orders: the ethical balancing act in community mental health.” Journal of Psychiatric and Mental Health Nursing 16 (2009): 177-186. Print.
The Principles of Medical Ethics: 178-181. Print.