Introduction to Clinical Ethics -6-

Co-operation of Medical Staff, Patient and Family

Two specialised rules result from P1:

R1-1: Share each medical activity with the persons involved in it.
R1-2: Stand by the person you face (share the person's concern).

As regards the rule R1-1, medical activities might appear, at first glance, to be performed only by the medical staff for the patient. But if a person intends to treat another person as a human being, that person cannot perform any acts on the other by himself. Rather, he/she should carry out such acts through a process of truthful communication with the other person in such a way that the other can also commit himself to the act and participate in it. The patient's family is also involved in the medical activities conducted for the patient. The disease that affects the patient sometimes affects the life of the family. The patient might no longer be able to work and this might cause a financial problem for the family. Further, family members might have to change their schedules depending on the patient's choice of treatment. Thus, in many cases, the family is more or less involved in the medical activities concerning the patient.

According to P1 that prescribes respect for human beings, it is appropriate that the medical staff, the patient, and other persons involved (e.g., the family) co-operate in medical activities, specifically, with respect to shared decision making. Under this rule, the patient's informed consent is necessary in the process of shared decision-making. Informed consent is also needed on the part of the medical staff. In order to choose an appropriate form of treatment, the medical staff need to obtain information about the patient from the patient himself, especially concerning his/her life-plan, preferences and values. Then, they should recognize the patient's request in such information, and consider how to reply to the request; this is what I call "informed consent on the part of the medical staff". Based on the informed consent of both sides, both can subjectively perform the chosen activity. Thus, the medical staff as well as the patient play a role in performing the chosen activity.

Consequently, though R1-1 recommends that the medical staff respect the patient's self-determination, it does not imply that the medical staff should follow it blindly . On the contrary, even the medical staff, as human beings, should be autonomous and willingly make joint decisions with the patient .

Moreover, the patient does not have the right to die, though he has the right to choose his way of living. Nor does he have the right to refuse all treatment, though he is allowed to refuse a particular treatment and to request another in its place according to his view of life. Generally speaking, I agree that "it is the patient's body, and in turn the patient's life, that bears the principal effects of any treatment instituted ". It does not follow, however, that the patient has the right to decide by himself how to treat his body or life , but he/she needs to negotiate with the people involved and reach an agreement concerning it.

update: 15/August/2003



[Index page of this introduction]