Tuesday, October 11, 2011

Relativism and Autonomy

I want your opinion:

A 48 year-old black women has developed stage III non-Hodgkin's lymphoma and needs combination chemotherapy for treatment. Without therapy she has no hope of survival beyond a few weeks or months. With therapy she has an 80% chance of complete remission. She understands this entirely, but insists that she simply does not want the therapy. There is no evidence of depression.
Which of the following is the most appropriate action?
  1. Honor the patient's wishes
  2. Ask the family for their opinion
  3. Offer radiotherapy instead
  4. Psychiatric evaluation
  5. Seek a court appointed guardian
  6. Risk management evaluation
This was a question on our Medical Ethics midterm. The correct answer was (A) because the end-of-life lecture heavily emphasized autonomy. (Because I know how to jump through hoops, I knew the answer they wanted, but I chose (C) in defiance. None of the other answers make sense; the patient is competent.)

But (A) does not make sense, given the information provided. The principle of autonomy does not allow a physician to lay aside his duty (rather, it binds him to respect the dignity of his patient as equal to his own). Choice (A) does not respect this patient; it betrays her.

The real answer is neither (A) nor (C). The real answer is: sit down with the patient; find out why she does not want this treatment. Her risk-to-benefit ratio is so low! What is she afraid of, or what does she believe about this treatment? And how can I help allay help her make the right choice?

Our Ethics class has operated from the very first lecture on the premise that there are no right answers. As a result, there is no "right choice" for a patient to make in a given situation. There is only the patient's desires and the doctor's opinion. In a world where there are no right answers, (A) makes sense. Ironic that I got the answer wrong in this world of relativism.

I'm contacting the course administrator about the question; we'll see what happens. (The grade does not matter, but the truth does.)


  1. You want an honest opinion. OK ... here goes.

    I cannot comment on C D or E as I am not a lawyer/doctor in your country. You must follow your legal/medical systems and rules.

    In a real life situation, you are 100% correct to choose to discuss the matter honestly and openly with the patient, explaining the risk to success ratio and trying to understand and alleviate her fears. Perhaps also discussing her treatment with her family. That's the correct "real life" option for you.

    But you're not in real life. You're a student and your objective is to pass your exams and qualify as a doctor. You were wrong to choose C in defiance. When in a student situation, as I was, the objective is to answer the way those in authority would want you to. Believe me, many a time I did not agree with my tutors, but I answered the way they wanted in order to get my qualifications.

    You have the makings of a good medic with great Christian ethics. We need people like you in medicine. God needs Christians like you in positions of authority. It is only by having good Christians in authority that we have a chance of making this world a better place.

    Please, please, don't risk your success and career for the sake of defiance.

    Your choice was right, but your tutors need not know so, not for now. Give them the answer they want even though your heart knows better.

    May God bless you always and bring you success in your chosen profession.

  2. Thank you for your thoughts. I recognize your very valid point: I am not in medical school for myself; I am for others. I was hasty, and I'm not sure I would choose (C) again.

    Fortunately, the test was an online module that we were allowed to take twice. On the retake, my answer is (A).

  3. God bless you for your wisdom and may He be always with you.

    I look forwards in celebration to the day when you are a fully qualified medic.

    Best wishes.