Medical ethics aided by advance input

Who would you choose to make life or death decisions on your behalf?

Do you believe that medical ethics is an area of philosophy that doesn’t apply to you?

Many share that misconception. The principles of bioethics — autonomy, confidentiality, beneficence and non-maleficence — certainly sound like high level philosophical concepts. No wonder people assume that they’re not relevant to their everyday lives.

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In reality, ethics is at the core of your relationship with doctors and other healthcare providers. Although we seek to help our patients (the principle of beneficence), this must be balanced with the risk of doing harm. Every treatment, medication and test carries potential risks, including side effects and complications. For this reason, the first rule of medicine is to do no harm  (non-maleficence).

Tests and treatments, including medications and procedures, are merely the tools of medicine: ethics guides us in their use.

In the practice of medicine, we have evidence-based protocols and guidelines on the best treatment of specific medical conditions, such as an acute stroke or heart attack. They are continually being updated based on clinical research. However, the treatment that individual patients would choose for themselves may not be what the guidelines recommend.

In healthcare, we do not treat medical conditions in isolation — we treat the whole person in the context of a unique life. Individual autonomy (the ability to make one’s own choices) is a fundamental guiding principle.

For example, if a previously capable adult was unconscious after suffering life-threatening blood loss in an automobile accident, the emergency doctor may recommend a blood transfusion to save his life. However, if that patient when capable left clear written instructions that he would not accept a blood transfusion under any circumstances, his wishes would be respected by the physician even if family members want him to receive the blood.

During the time that Burnaby Hospital had its own Ethical Resources Committee, I was the chair for 17 years. In my last 10 years in that role, I led a team providing ethics consultations at the request of families, patients and healthcare providers when they couldn’t agree on the best course of action.

Many of the patients we were asked to see were in the intensive care unit or in long-term care, where it wasn’t clear if life support such as machine-assisted breathing, feeding tubes and IV fluids would provide benefit to the patient. In all cases, the patients were unconscious or for other reasons no longer capable of understanding their situation, making medical decisions and communicating their preferences to the care team. In none of the cases had the patients put anything in writing in the past when they were capable of giving consent.

Family members would then have to make heart-wrenching decisions on behalf of the patient based on what they thought their loved one would want. Dilemmas arose when family members disagreed with one another or with members of the hospital care team.

Sometimes, it wasn’t clear which family member was the most appropriate decision maker on behalf of the unconscious or otherwise incapable patient.

If you were the patient, who would you choose to make decisions on your behalf?

Would they respect your values and all that gives your life meaning? Who has the right to see your medical records? Under what circumstances may you lose the right to make your own decisions? How do you make your wishes known in advance?

I will address these questions in upcoming columns and at 7 p.m. Tuesday, April 7, at the Bonsor Recreation Complex. I’ll be speaking on a topic relevant to your care both in and out of the hospital in a lecture called “What You Should Know About Medical Ethics.”

This free public talk is part of the Burnaby Division of Family Practice’s Empowering Patients education series. For more information, call Leona Cullen at 604-259-4450 or register online at lcullen@divisionsbc.ca.

Dr. Davidicus Wong is a family physician. For more information on the Burnaby Division of Family Practice’s public health education series, check our website at divisionsbc.ca/burnaby. For more on achieving your positive potential at every age: davidicuswong.wordpress.com.

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