Leora Tuchman

Professor Timothy Kirk

Biomedical Ethics

11 December 2017

Reflective Essay

Over the past semester we have discussed a number of ethical principles that should be considered when making medical decisions.  This essay will discuss the principles I hope will guide my practice throughout my career.

Choosing to become a physician assistant was not a simple decision for me.  I searched for a profession that would engage many of my interests including continuing my education in biology, challenging myself intellectually, and connecting with different people.  The role of the physician assistant serves as the intersection between medicine and the patient advocate; the person who is not only there to treat the patient’s ailment but to care for and support the patient while recognizing the patient’s unique background and set of experiences.  I expect my career as a physician assistant to be challenging, emotionally taxing, often frustrating but deeply rewarding and satisfying.

I am most looking forward to the relationships I will form with my patients.  In preparing for physician assistant school, I spent time in different healthcare settings and got the chance to observe different provider-patient relationships.  I was able to observe physicians and PAs who made the patients feel comfortable and who let the patients know they were not being judged.  I also was able to see the interactions that created discomfort and reluctance in the patient.  As a clinician, I hope to create an atmosphere that allows patients to feel comfortable to discuss any questions or concerns openly.  I hope my interactions as a clinician will be as much empowering and reassuring for the patient as they are medicinal and therapeutic.

I believe that the principles that will play the biggest role in my ethical decision making will be autonomy and confidentiality.   Autonomy is understood as the patient’s right to make decisions about his or her healthcare.  According to Miller, it can be divided into four categories: (1) autonomy by free choice, (2) autonomy as effective deliberation, (3) autonomy as authenticity, and (4) autonomy as moral reflection.  (Yeo 95). Confidentiality is explained as protecting the information the patient shares.  More broadly, it is understood as the actions that create the trusting relationship between the patient and the clinician. (Kirk 279)

Although it can be explained simply as letting the patient decide for himself, the principle of autonomy carries with it a broader set of responsibilities of the clinician that I find compelling.  Because Miller sets up conditions that evaluate a patient’s autonomy, it can be argued that a patient’s autonomy is limited if all these conditions are not met.  As a clinician, it is my duty in such a case to restore a patient’s autonomy.  In these situations it is my responsibility to educate the patient about symptoms and treatment, facilitate conversations between family members and remove any other barriers that may be preventing the patient from making an autonomous decision.  Gadow describes this process as existential advocacy, which creates the environment for patients to “discern and clarify their values in the situation, and on the basis of that self-examination, to reach decisions which express their reaffirmed, perhaps recreated, complex of values.” (Yeo 105). Instead of accepting a patient’s compromised state as placing unavoidable limits a patient’s autonomy, it should be seen as a challenge to empower the patient.  I see this as a compelling part of the profession and a guiding factor in the way I hope to treat patients.  Sickness is frightening and patients often feel a loss and control and personhood.  I believe that my emphasis on the patient’s autonomy in my practice will allow the patient to regain his independence in an otherwise trying, and sometimes debilitating situation.

By putting the need to maintain confidentiality at the forefront of my practice, I will be emphasizing my commitment to strong, reliable relationships between my patients and me.  This will not only preserve their integrity but also ensure their safety and hopefully, lead to positive patient outcomes. Beyond its traditional understanding, of keeping secrets, confidentiality as an ethical principle should serve “to establish or maintain confidence, or trust in the relationship between the patient and the provider.”  (Kirk 279). This explanation stresses that using discretion when treating patients is not as much intrinsically valuable as it is a means in creating a trusting and open dialogue between the patient and clinician.  Confidentiality accomplishes two important goals I have in pursuing my practice.  First, it expresses the clinician’s respect for the patient’s personhood.  While sickness may strip a patient of his health and strength, a trusting relationship between the clinician and patient keeps the patient’s personhood intact, and engenders respect for his decisions.  In addition, it allows the patient to speak openly about sensitive topics and share pertinent information that is necessary in proper treatment.

I hope my career as a physician assistant is a process of ongoing growth in medical knowledge and patient-clinician relationships.  It is important to me to maintain and adhere to these values in my efforts to treat each patient as the individual person he is.

 

Works Cited

Kirk, TW. (2015).  Confidentiality.  In N Cherny, M Fallon, S Kaasa, R Portenoy, & D Currow (eds.). Oxford Textbook of Palliative Medicine. (5^th ed.) New York/London: Oxford University Press, pp. 279-284.

Moorhouse, Anne, and Jean Dalziel. “Autonomy.” Concepts and Cases in Nursing Ethics. By Michael Yeo. N.p.: Broadview, 2010. 91+. Print.