Respecting a Patient's Right to Choose

The basic rights of human beings emphasize the importance of decision, behavior, action, expression, and protection by law. In healthcare, it is essential to respect the rights of all individuals who step foot in a health facility. Patient rights include the right to make medical decisions, the right to accept or refuse treatment, the right to create advance directives, the right to respect and dignity, the right to safety and security, as well as the right to privacy and confidentiality. Patient responsibilities include the responsibilities of patients so that healthcare professionals can provide proper care, address their needs and preferences, make accurate and responsible medical decisions, and maintain a safe environment.

Patients’ rights differ among countries, in accordance with the cultural and social norms. Moreover, there are also several different models of the doctor-patient relationship, which are formed based on doctors’ obligations and the particular rights entitled to patients’. For instance, in the United States and in Europe, there are 4 models that represent the doctor-patient relationship: the interpretive model, the paternalistic model, the deliberative model, and the informative model. In the interpretive model, the doctor helps patients discover their values and choose a treatment plan that best fits within these values. In the paternalistic model, the doctor plays a parental role and decides which treatment plan is the best fit. In the deliberative model, the doctor helps patients uncover health-related values and choose their treatment plan based on these values. Finally, in the informative model, the doctor informs patients of their treatment options and necessary medical information, but the patients choose their own treatment plan. Throughout the years, there has been a debate about which model is the best approach. The deliberative model has been considered the most ideal; however, nowadays, a shift has been made toward the informative model.

Still, a great deal of research needs to be performed in order to clarify the relationship between human rights and the right to healthcare, more specifically, patients’ rights. As a doctor, you tend to work with patients and their families who are making medical decisions and the main objective is to shift care in the right direction. However, how much control should patients have over their medical decisions? This is a question that should be answered with “as much control as possible”. For instance, if a patient does not want a flu shot, vaccination or wishes to choose an unconventional treatment, your role is to educate them about all possible options and outcomes. It is your responsibility to help each patient make better-informed decisions, no matter the situation.

The notion of autonomy, in terms of making relevant medical decisions, is considered to be defined by two principles. The first principle being that in order for a patient to be autonomous, he or she needs to have sufficient knowledge of their health and explore all their options so that they can make the best decision relevant to their needs. Sometimes, this knowledge is lacking and you may need to step in to present a more-simplified version of a diagnosis, procedure, or treatment plan. A patient may be aware of their diagnosis; however, they may not understand the whole story. Here, you have an obligation to provide relevant information so that the patient can make an informed decision relating to their health. The second principle refers to a patient’s right to informed participation in medical decisions regarding his or her care to the greatest degree possible. If a patient is in an impaired state (in pain or experiencing emotional trauma) and incapable of making rational and informed medical decisions, care must be given by the healthcare team and in accordance with the patient’s needs. Still, you and your team are obliged to encourage the patient’s involvement in their care plan and help in their decision-making process.

Though a patient’s right to choose should be respected, autonomy is limited when an activity can cause harm to a patient or to others, as well as violates your integrity. For instance, if a patient seeks antibiotics for their medical condition and you refuse the antibiotics due to their negative consequences, it is necessary to determine whether the patient fully understands the extent of their implications. While in some instances, other considerations should be taken into account, such as a patient’s mental status or their ability to cause harm to their surroundings if their preferences are not met, autonomy generally represents a reality that is based on open communication, patient education and well-being. Autonomy is not a standard that disappears when a right is deprived. It is a principle that is aimed toward providing patient care at a respectable and honorable level. If a patient is fully capable of making their own medical decisions, you should respect their right to choose unless their desires can cause harm to their own well-being or to the well-being of others.

As a doctor, you should serve as a patient advocate because essentially, your duty is to promote patient rights and provide quality care. Open and truthful communication is a vital component of the doctor-patient relationship and it is an ethical requirement. Patients have a right to understand their medical status – both past and current - and they have a right to have their questions and concerns addressed. By dealing openly and honestly with your patients, you can ensure their understanding and raise awareness of future medical care. Moreover, a large part of open communication is informed consent for medical procedures and treatment. This is a basic patient right and it is outlined by a patient’s understanding of what you are proposing, the purpose of the procedure / treatment, the possible side effects of the procedure / treatment, as well as the benefits and risks associated with the procedure / treatment. Voluntary consent means that a patient understands the above concepts and has the right to accept or refuse care, the right to ask questions, the right to negotiate certain aspects of the procedure / treatment, and the right to be free from fraud, force, and deceit. Within a clinical setting, competence is equal to capacity and if a patient is competent to provide voluntary and informed consent, he or she is considered capable of standing by their autonomous and informed decision. Finally, the law states that the doctor-patent relationship must remain confidential. That is, the doctor should never reveal private patient information unless the patient offers consent for disclosure or unless the doctor is obligated to do so by law.

Ultimately, it is the physician who is the patient advocate and who offers care to patients, their families, and the community on a whole. It is he or she who advocates on a small level for each individual patient and on a larger scale for the entire patient population. “The entire purpose of my profession is to learn about humans — their biology and chemistry, their function in health, and dysfunction in illness and injury. We strive to understand the impact of health or illness and injury on the psyche and on social interactions. To learn about and discover treatments and interventions, and to provide compassion and comfort in applying them. To educate both patients and our society in order to prevent illness and injury, promote health. We are called to speak truth to power in order to accomplish these goals. The foundation of all this is the relationship and trust between the physician and the patient. Central to this relationship, that trust is the role of the physicians as advocates for their patients,” wrote Kathryn A. Hughes, general surgeon.

The power of information – it allows us to better understand our choices and rights. In healthcare, patients should be informed about their choices and healthcare professionals should respect their preferences. Shared medical decision-making is not only an effective way to combat health issues, it also puts you and your patients in control of health.