25 Apr Patient Autonomy and Informed Consent Week One CaseStudy
1. In the case study, do you believe the ends justify the means? In other words, does the goal of discharging the patient from an institutional setting into everyday community living justify deceiving him? Explain your reasoning.
2. Do you think it is ever ethically permissible to deceive clients? Under what circumstances? Why or why not?
3. To what degree should family members or legal guardians have full capacity to make decisions or give consent on behalf of those under their care? Explain.
4. Do you think severely mentally ill people retain any rights “to determine what shall be done with their own bodies?” Why or why not?
Case Study
In the context of U.S. healthcare, Justice Benjamin Cardozo expressed the value of autonomy and liberty in Schloendorff v. Society of New York Hospitals (1914), stating that individuals have the right to determine what happens to their own bodies. This case established informed consent as a crucial principle in modern medical ethics. However, subsequent events have shown instances where patient autonomy has been overridden. For example, in Buck v. Bell (1927), involuntary sterilization of “mental defectives” was deemed justified by Justice Oliver Wendell Holmes. The Tuskegee Syphilis Study, which lasted from 1932 to 1972, also violated patient autonomy by withholding treatment from African-American males.
The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research emphasized the importance of informed consent, recognizing that adults have the right to accept or reject healthcare interventions based on personal values and goals. However, there are cases where patients are deemed incompetent, and someone else is designated to make decisions on their behalf.
Consider the following case: A middle-aged man, declared mentally incompetent, was involuntarily committed to a psychiatric hospital due to severe paranoid thinking. His adult son, granted guardianship and medical power of attorney, made decisions regarding the use of psychotropic medications to control the patient’s violent behavior. Despite the medications’ limited impact on the patient’s paranoid symptoms, a new drug in pill form showed promise for his return to the community. The suggestion to mix the pill in his pudding to address the patient’s fear of being poisoned arose. Hospital staff obtained informed consent from the son, who prioritized the patient’s living outside the institution and close to loved ones. However, the staff felt uneasy about deceiving the patient despite obtaining consent from the guardian. Use this scenario as the basis for your assignment. You are the caregiver. How would you feel?
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