When I was younger, I always saw tattoos as the definitive symbol of defiance and rebellion; a true sign of the independent spirit. It seems that my ideas were not so far off, though not perhaps in the ways that I imagined. A 79 year old women in New Zealand is tattooing the command "Do not resuscitate" onto her chest as a sign of her autonomy, that is, as her right to choose what medical treatment she receives. It seems that, amidst the swell of exotic lifesaving therapies in recent years, patient autonomy has become the rebel's cause as it inspires people like the woman in New Zealand to take ever more dramatic efforts to ensure that their wishes are honored in a medical setting.
As referenced in the article that the story was reported in, a looming concern is that doctors will not know what to do when confronted with the tattoo in an emergency room after this woman has had a heart attack or stroke. Has she changed her mind? Was she under compulsion when she got the tattoo? Was she depressed when she got the tattoo? A "yes" to any of these questions would certainly endanger the force of the "Do not resuscitate" command. And therein lies the problem, if the woman is unconscious, which way does the hospital err in providing care? Generally hospitals have erred on the side of resuscitating so as to preserve life, and thus the reason why this woman has taken such a bold effort to ensure that her message is loud and clear. It is very interesting, though, to observe that the greater effort a person goes to refusing medical care, or otherwise bucking the status quo of modern medical care, the more they are questioned and examined for signs of compromised autonomy.
To be fair, patients do change their minds, and sometimes they do things under some degree of duress that compromises their ability to make a fully informed decision. As such, it is somewhat understandable why medical providers hesitate to consider whether to honor a patient's request (particularly when they are unconscious). However, outside of epistemic humility, is there a failure on the part of the medical establishment to respect the value of patient autonomy? In the last 40 years, the four primary values utilized in the vast majority of medical ethics decisions have been autonomy, beneficence, non-maleficence, and justice. Oftentimes, discussions center around issues of autonomy, but do such discussions ever actually lead to a more credible place for autonomy in the medical clinic? Certainly beneficence is an undisputed part of the medical establishment. Doctors, nurses, and other health care providers are all dedicated to serving the needs of sick individuals and bringing about a great good in their lives through healing.
Sometimes, though, it seems that the medical establishment just does not know what to do with instances of patient autonomy? Certainly inside of a model of paternalism, where an attitude of "doctor knows best" reigns, we would expect some degree of dissonance with a patient's attempt to assert an alternative perspective that they expect to be honored against that of a doctor. But these are the days of the doctor-patient alliance, wherein doctors and patients collaborate to develop a treatment plan for medical care, right? It is worth wondering whether, after centuries of utilizing the model of paternalism in medical practice, the medical establishment has so quickly left the attitudes of paternalism behind. Could it be that the dogged inquisition of a patient that chooses to reject medical care or otherwise buck the status quo, is not a sign of epistemic humility on the part of medical professionals, but more sinisterly the specter of paternalism? If so, are these rebel patients, so to speak, to be regarded not as incompetent, but rather, as the brave individuals who dared to challenge an entrenched system of power?
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